145 
155 


^IfikH 

UC-NRLF 


B    3    103    fl3b 


Ci*,irjy.  ■:.  ^,-    ----- ■■.>-..-■.■.^.i-^  :   . 


AiN  ESSAY 


r 


O.X  THE 


BLOOD  IN  DISEASE. 

BY 

G.  ANDEAL. 

TRANSLATED  FROM  THE  FRENCH 

BY 
J.  F.  MEIGS,  M.D.,  AND  ALFRED  STILL6,  IVI.D. 


BMMM 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 

MRS.  PRUDENCE  W.  KOFOID 


/ 


■.    .;V  >:*  ^.l.\j.-.f^tC\ 


PATHOLOGICAL   HJIMATOLOGY. 


AN    ESSAY 


ON    THE 


BLOOD   IN   DISEASE. 


BY  G.  ANDRAL, 


PBOFBSSOR   OF  GENERAL  PATHOLOGY  AND   THERAPEUTICS  IN   THE  DNIVERSITT  OF  FAHIS, 

ETC.  ETC. 


TRANSLATED  FROM  THE  FRENCH 


BT 


J.  F.  MEICS,  M.D.  AND  ALFRED  STILLE,  M.D. 


^Non  ideo  analyses  sanguinis  ulilitate  svtH  desiiluuntur,  dum  sapienier  noverinius  spel  nos- 
tras recidere,  neque  plura  docere  quim  a  nature  discimus. — Haller,  Elem.  Physiolt,  lib.  v. 


PHILADELPHIA: 
LEA    AND    BLANCHARD. 

1844. 


TABLE  OF  CONTENTS. 


CHAPTER  I. 

4 

Of  the  best  method  to  puHsrE  in  the  study  of  Pathological  H.ema- 


t 


TOLOGT,        .-.--...---15 

CHAPTER  n. 

Of  the  Blood  ik  Diseases,  .--- 36 

Article  I. — Of  the  blood  in  Plethora,       ---...  38 

"       II. — Of  the  blood  in  Anaemia,           -        -        j        -        -        -  43 

"      III.— Of  the  blood  in  Pyrexiae, 52 

"    .  IV.— Of  the  blood  in  the  Phlegmasiaei 6d 

• 

"       V. — Of  the  blood  in  Hemorrhages, 92 

«      VI.— Of  the  blood  in  Dropsies,          -        -        -.       -        -        -  107 

"    VII. — Of  the  blood  in  certain  diseases  commonly  called  organic,  117 

«   AlII.— Of  the  blood  in  the  Neuroses, 128 


« 


ESSAY 


upon 


PATHOLOGICAL  HiSMATOLOGY. 


HiEMATOLOGY  is  that  branch  of  the  natural  sciences  the 
subject  of  which  is  the  study  of  the  blood.  This  expression 
is  not  a  new  one  in  science  :  about  a  century  since,  an  autlior 
now  but  little  known,  Thomas  Schwenke,  published,  under 
the  title  of  Hasmatology,  a  treatise  as  complete  as  it  could 
then  be,  upon  the  blood  considered  in  its  state  of  health  and  of 
disease.* 

Before  this  author,  and  Since  his  period,  many  works,  some 
theoretical,  some  experimental,  -have  been  published  on  the 
blood;  their  simple  enumeration  would  be  a  considerable  un- 
dertaking, and  one  not  without  utility ;  such  however  is  not 
the  end  that  I  seek  :  but  I  come  to  add  to  all  these  works,  of 
various  importance,  a  new  one,  in  which  I  design  to  make 
known  the  alterations  that  the  blood  has  presented  me  in  dif- 
ferent diseases,  under  the  triple  view  of  its  physical  proper- 
ties, and  of  its  chemical  and  microscopic  constitution.  I  shall 
endeavour  to  estimate  the  importance  of  these  alterations  in 
regard  to  semeiology  and  pathogeny,  and  I  shall  discuss 
finally  the  value  of  the  methods  that  have  been  followed  at 
different  periods  for  the  purpose  of  discovering  the  facts  of 
pathological  hasmatology. 

•  Thomas  Schwenk  Hsematologia,  sive  sanguinis  historia,  experimentis 
passim  superstructa,  in  8°  Hagcecomitum,  1748. 
2 


fvi354496 


14  PATHOLOGICAL  HEMATOLOGY. 

Already  in  two  memoirs  read  at  the  Academy  of  Sciences 
in  1840  and  1842,  I  have  exhibited  the  results  that  I  ob- 
tained, in  seeking  to  appreciate  the  variations  of  proportion, 
that  some  of  the  principles  of  the  blood,  to  wit,  the  fibrme,  the 
globules,  the  solid  elements  of  the  serum,  and  the  water,  may 
offer,  whether  in  disease,  or  in  different  states  of  the  physio- 
logical condition.  To  accomplish  these  researches  I  have  fol- 
lowed the  method  indicated  by  M.  Dumas,  one  which  he  him- 
self advised  me  to  have  recourse  to,  as  answering  the  end  that 
I  sought  to  attain.  May  he  permit  me  to  express  to  him  on 
this  occasion  my  gratitude  for  all  his  kind  advice. 

In  the  work  that  I  now  publish,  I  have  sought  to  give  a 
greater  development  to  the  facts  and  ideas  contained  in  my 
preceding  memoirs :  there  will  be  found  in  addition  a  certain 
number  of  results  that  I  have  obtained  more  recently,  and 
which  have  not  yet  been  made  public.  For  many  of  the  de- 
tails and  ciphers  I  will  refer  the  reader  to  the  two  other  me- 
moirs ;*  for  I  do  not  pretend  to  give  to  the  world  a  finished 
and  complete  essay — even  while  continuing  my  researches,  I 
desired  to  indicate  the  point  to  which  they  had  attained,  what 
results  they  had  yielded,  and  what  it  may  be  possible  to  arrive 
at,  if  the  pursuit  does  not  become  wearisome. 

*  Recherches  sur  les  modifications  de  proportion  de  quelques  principes 
de  sang  (fibrine,  globules,  materiaux  solides  du  serum,  et  eau)  dans  les 
maladies,  par  MM.  Andral  et  Gavarret  (^Annales  de  chimie  et  de  physique, 
tome  LXXV).  Recherches  sur  la  composition  du  sang  de  quelques  ani- 
maux  domestiques  dans  I'etat  de  sant^  et  de  maladie,  par  MM.  Andral,  Ga- 
varret et  de  la  Fond  (Annales  de  chimie  et  de  physique,  3d  serie  torn.  v.). 

The  results  detailed  in  these  two  memoirs,  as  well  as  those  contained  in 
this  new  work,  are  the  fruit  of  researches  common  to  myself  and  to  M.  Ga- 
varret, to  whose  learned  and  devoted  collaboration  I  am  greatly  indebted. 
For  the  facts  relating  to  animals,  M.  de  la  Fond,  professor  at  the  veterinary 
school  of  Alfort,  kindly  lent  us  the  aid  of  his  time  and  experience. 

The  method  that  we  have  followed,  and  the  results  that  it  has  given  us, 
having  been  the  subject  of  several  criticisms,  we  have  thought  proper  to  an- 
swer these  in  a  separate  work,  to  which  I  shall  also  refer  from  time  to  time, 
and  which  has  for  title :  Reponse  aux  principales  objections  dirigees  contre 
les  procedes  suivis  dans  les  analyses  du  sang,  et  contre  Vexactitude  de  leurs  resul- 
tats,  brochure  in  8°,  1842,  chez  For  tin  et  Masson. 


THE  BEST  METHOD  OF  STUDY.  15 


CHAPTER  I. 

OP  THE  BEST  METHOD  TO   PURSUE  IN  THE  STUDY  OP  PATHO- 
LOGICAL HEMATOLOGY. 

It  was  one  of  the  dogmas  professed  by  the  school  of  Cos, 
that  in  order  to  explain  the  phenomena  of  health  and  of  dis- 
ease, we  must  take  equally  into  consideration  the  solids  which 
enter  into  the  composition  of  the  human  body,  the  fluids  with 
which  it  is  so  abundantly  provided,  and  the  forces  which  con- 
trol it.  But  few  physicians  however  remained  faithful  to  these 
principles,  which  Hippocrates  has  declared  in  several  of  his 
works,  and  particularly  in  his  book  on  ancient  medicine;  and 
we  find  Galen  reproaching  his  contemporaries  with  some  bit- 
terness, for  having  broken  this  beautiful  ensemble  of  the  an- 
cient Grecian  school,  in  order  to  interpose  in  their  explanation 
of  disease,  some  only  the  solids,  others  only  the  fluids,  and 
others  again  only  the  forces  which  pervade  and  animate  or- 
ganized matter.  *  And  thus  were  determined  from  those  ancient 
times,  the  three  great  points  of  view,  which,  now  abandoned, 
and  now  again  adopted,  have  produced  the  three  systems  of 
solidism,  humorism,  and  vitalism. 

One  of  the  characteristics,  and  I  venture  to  say  one  of  the 
glories  of  the  present  medical  epoch,  is  to  have  understood  to 

•  Hippocrates,  cum  trifariam  hominis  elementa  divisisset,  in  continentia, 

contenta,  et  ea  quae  impetum  faciunt ,  baud  scio  quomodo  successores 

ejus  unam  illam  revera  divinam  JEsculapii  medicinam  ia  tres  partes  sibi 
cobffirentes  distribuerint  atque  divulserint.  Alii  enim  liumidis,  turn  causam 
eorum  quas  secundum  naturam  babent  constitutionem,  tum  causam  eorum 
quae  praiter  naturam,  solis  attribuere,  ut  Praxagoras  etHerophilus.  Alii,  soli- 
dis  corporibus  initia  et  elementa  atiribuentes,  ex  his  tum  quae  natura  consis- 
tunt,  tum  morborum  causas  inde  capiunt,  et  Erasistrates  et  Asclepiades, 
Athenaii  vero  et.Archig:enis  imitatores,  spiritu  solo  ea  penetrante,  tum  natu- 
ralia  consistere  ac  gubernari,  tum  morbos  universes  hoc  prius  offenso  creari 
dixerunt.  (Medicus.) 


16  PATHOLOGICAL  H^MATOLOGT. 

what  incomplete  and  necessarily  erroneous  results  these  minute 
subdivisions  of  the  science  conduce;  and,  at  the  same  time 
that  it  has  given  a  due  degree  of  importance  to  dynamism  and 
solidism  in  pathogenic  theories,  it  has  returned  to  the  study 
of  the  alterations  of  the  blood;  it  has  recognized  their  exist- 
ence, and  has  accorded  them  an  influence  in  the  production 
of  disease.  But,  singular  fact !  these  alterations,  of  which 
the  reality  and  importance  are  no  longer  denied  by  any,  are 
nevertheless  scarcely  known,  and  but  few  facts  could  be  cited 
in  proof  of  the  convictions  arrived  at  on  this  subject;  direct 
observation  of  the  blood  has  thus  far  been  much  more  rarely 
invoked  than  theory,  and  when  recourse  has  been  had  to  ob- 
servation, it  has  been  made  use  of  most  frequently  only  to  study 
in  the  sanguine  fluid,  the  simple  alterations  of  its  physical  pro- 
perties. But  thus  we  remain  ever  in  the  infancy  of  the  sci- 
ence ;  to  progress,  we  must  analyze  the  blood :  such  is  the 
idea  which  guided  M.  Magendie  when,  by  modifying  artifi- 
cially its  composition,  he  proved  that  we  can  by  these  means 
create  disease.  Pathological  hasmatology  will  begin  to  be 
enriched  with  facts  of  some  value,  only  when  the  blood  of  a 
great  number  of  patients  shall  have  been  submitted  both  to 
chemical  investigation,  and  that  by  the  microscope.  Doubt- 
less, while  studying  by  this  double  means  of  analysis  the 
different  elements  of  that  fluid,  and  while  thus  following  them 
one  by  one  in  all  their  possible  variations  of  proportion  and 
nature,  we  must  not  neglect  the  study  of  the  changes  it  may 
undergo  in  its  physical  properties ;  but  we  soon  discover  that 
this  latter  mode  of  examination  is  almost  always  insuflicient, 
and  that  when  employed  alone,  without  the  control  of  analysis, 
it  may  often  become  a  source  of  error.  For  we  should  be  un- 
able to  give  an  exact  account  of  the  different  modifications  that 
the  blood  is  susceptible  of  in  its  physical  properties,  unless  we 
have  learned  to  connect  these  changes  with  others  more  inti- 
mate occurring  in  the  composition  of  that  fluid,  and  of  which 
the  first  are  but  the  effects.  Thus  it  may  happen  that  the 
blood  shall  present  an  identical  appearance,  and  be  equally 
buffed  in  diseases  as  different  as  are  clilorosis  on  the  one  hand. 


THE  BEST  METHOD  OP  STUDY.  17 

and  pneumonia  or  acute  articular  rheumatism  on  the  other. 
But  is  the  blood  alike  in  chlorosis  and  pneumonia  ?  Does  the 
buff  in  these  two  diseases  have  the  same  signification  ?  This 
the  simple  consideration  of  the  aspect  of  the  fluid  could  not 
inform  us;  analysis  alone  can  reveal  it  to  us,  as  I  shall 
show  farther  on.  At  other  times  it  is  the  microscope  which 
becomes  our  chief  means  of  analysis ;  it  is  this,  for  example, 
which  will  reveal  to  us  alterations  of  quahty  in  the  globules,  or 
which  will  show  us  pus  in  the  blood,  etc.  Finally,  in  these  dif- 
ficult researches,  where  no  source  of  light  should  be  neglected, 
cheiTucal  and  microscopic  investigation  will  find  at  times  a 
useful  aid  in  physiological  experiments.  By  these  last,  in  fact, 
we  can  modify  in  animals  the  composition  of  the  blood,  and 
as  a  consequence  its  physical  properties,  in  such  a  way  as  to 
render  this  fluid  more  or  less  similar  to  what  it  is  in  certain 
diseases.  Once  these  modifications  produced,  we  observe 
what  are  the  phenomena  that  result  in  different  parts  of  the 
organism,  and  we  can  draw  conclusions  relative  to  the  influ- 
ence that  modifications  of  the  same  nature  occurring  sponta- 
neously in  the  blood  of  man,  may  exercise  in  the  production 
of  various  morbid  conditions.  It  is  by  acting  in  this  way  that 
M.  Magendie  has  shown  the  influence  that  blood,  less  than 
usually  charged  with  fibrine,  may  have  in  the  production  of 
sangume  congestions  and  hemorrhages.  By  the  direct  analy- 
sis of  the  blood  of  the  sick,  I  have  arrived,  in  this  respect, 
at  results  similar  to  his  own. 

Such  are  the  modes  in  which  we  must  necessarily  proceed, 
if  we  seek  to  give  some  impetus  to  pathological  haematology. 
Of  what  use  is  it,  indeed,  to  waste  oiu:  time,  as  has  often  been 
done,  in  mere  speculations,  on  the  part  played  by  the  blood  in 
the  economy,  on  the  reciprocal  influence  of  this  fluid  upon  the 
sohds,  or  of  the  solids  upon  it  ?  Of  what  use  is  it  again  to 
deduce,  by  reasonmg,  the  existence  of  alterations  of  its  com- 
position and  their  influence  in  disease,  from  a  consideration  of 
the  causes  and  symptoms  of  these  last  ?  Without  doubt  we 
may  there  find  strong  arguments  to  bring  forward ;  but  they 
can  conduct  only  to  simple  probabilities,  or  else  we  should  in 


18  PATHOLOGICAL  HiEMATOLOGY. 

this  way  always  remain  with  notions  so  incomplete  as  to  be 
most  frequently  useless,  and  sometimes  even  dangerous.  It  is  by 
this  method  that  some  have  supposed  the  blood  to  be  changed, 
and  this  change  to  be  the  point  of  departure  of  the  disease,  when 
this  disease  recognizes  as  cause  the  absorption  of  a  miasm, 
of  a  virus,  or  of  a  poison.  Yet  that  is  only  a  presumption,  and 
we  might  just  as  well  admit  that  the  blood,  in  cases  of  this  kind, 
serves  merely  as  a  vehicle  to  the  deleterious  agent  which  has 
traversed  without  altering  it,  in  order  to  pass  on  with  greater 
or  less  rapidity  to  attack  the  solids  alone.  I  might  cite  many 
other  examples  of  the  deplorable  uncertainty  in  which  we  are 
forced  to  remain,  while  from  the  nature  of  the  causes  or  of  the 
symptoms  we  seek  to  adduce  directly  the  nature  of  the  alter- 
ation that  the  blood  may  have  undergone ;  would  it  have  been 
possible,  for  exampje,  by  this  method,  to  recognize  the  difference 
between  the  alteration  of  the  blood  in  scm'vy  and  in  chlorosis  ? 
What  has  been  said  indeed  of  the  state  of  the  blood  in  these 
two  diseases  ?  Nothing  more  than  that  it  was  deteriorated,  and 
on  this  deterioration  all  the  symptoms  of  scurvy  and  of  chlorosis 
were  made  to  depend.  But  why  then  are  these  symptoms  so 
very  different?  It  is  because  the  nature  of  the  deterioration  is 
not  the  same  in  the  two  diseases ;  in  each  of  them  there  is  a 
different  element  of  the  blood  in  fault,  and  thus  analysis  teaches 
us  that  scurvy  and  chlorosis  are  not  diseases  of  the  same  nature, 
and  by  this  means  we  can  explain  the  great  difference  in  their 
symptoms,  notwithstanding  the  fact  that  a  deteriorated  blood 
exists  in  both.  Thus,  when  anatomy  fails  to  disclose  to  us 
any  change,  chemistry  brings  it  to  Hght,  and  I  doubt  not  that 
it  will  become  more  and  more  one  of  the  bases  of  pathogeny, 
notonly  as  is  the  case  particularly  at  present  by  analyzing  the 
fluids  modified  by  disease,  but  also  by  tracing  in  the  solids 
themselves  the  important >.study  of  the  changes  in  proportion 
and  nature  of  the  elementary  principles  which  compose  these 
solids. 

Besides,  it  is  not  only  in  our  day  that  the  idea  has  arisen  of 
seeking  the  origin  of  diseases  in  some  alteration  of  the  element- 
ary principles  which  enter  into  the  composition  of  the  bodies  of 


THE  BEST  METHOD  OP  STUDY.  19 

animals :  this  idea  was  brought  to  Hght  in  the  earhest  periods 
of  science;  but  for  a  long  time  remained  without  rcsuhs,  be- 
cause in  place  of  seeking  to  establish  experimentally  the  alter- 
ation of  these  principles,  nothing  more  was  done  generally 
than  to  suppose  it.   The  ancient  humorism,  during  every  epoch 
when  it  has  prevailed,  was  but  the  exaggerated  and  hypotheti- 
cal expression  of  this  idea.    It  is  found  entire  in  the  dogmas  of 
the  Grecian  philosophy,  which  attributed  diseases  to  a  certain 
number  of  modifications  occurring  in  the  elements,  of  which  it 
supposed  the  human  body  to  be  primarily  composed.     This 
doctrine  ruled  in  science  without  control  from  the  time  of 
Thales  down  to  that  of  Galen,  and  from  Galen  to  the  chemists 
of  the  sixteenth  century.     These   latter,  in  destroying  the 
ancient  doctrine  of  the  four  elements,  overthrew  likewise  the 
medical  theories  that  were  attached  to  it ;  but  they  preserved 
its  original  idea ;  for  they  also  determined  that  the  origin  of 
diseases  ought  to  be  referred  to  a  vicious  combination,  or  to 
some  alteration  of  the  simple  principles  which  they  thouglit  to 
have  discovered  in  nature  at  large,  and  in  organized  bodies  in  - 
particular.     They  troubled  themselves  but  little,  however,  to 
make  experiments  for  the  purpose  of  proving  their  assertions ; 
what  they  saw  take  place  in  their  crucibles,  they  boldly  con- 
cluded must  occur  also  in  the  living  body  ;  they  made  the  acids, 
alkalies  and  salts,  which  they  had  discovered  in  the  organs,  , 
react  in  their  interior,  without  endeavouring  by  experiment  to 
prove  the  reality  of  these  reactions;  and  in  this  way  they 
arrived  in  their  pathogenic  doctrines,  at  the  strangest  concep- 
tions :  there  remains  to  us  for  example,  a  nosology  of  this 
epoch,  by  Schenneman,  a  disciple  of  Paracelsus,  in  which  that 
author  makes  ten  classes  of  diseases,  which  he  founds  upon  a 
certain  number  of  modifications  occurring  in  three  principal 
constituents  of  the  body,  to  wit :  mercury,  sulphur,  and  salt.* 
At  this  period,  Sylvius  Deleboti  sought  to  found  a  complete 
medical  system,  by  ascribing  diseases  to  an  alteration  of  the 


•  See  Sennerti  operti,  torn,  i,  do  cheinicorum  cum  Aristotelicis  etGalenicis 
consensu  ac  dissensu  liber,  cap.  iii. 


20  PATHOLOGICAL  HiEMATOLOGT. 

principles  which  chemistry  had  just  discovered.  He  assigned 
a  prominent  part  in  the  production  of  diseases  to  the  state 
of  acidity  or  alkalinity  of  the  humours.  One  of  the  most  fre- 
quent causes  of  fever,  according  to  him,  was  an  dcre,  possessed 
of  different  chemical  properties,  which  irritated  the  heart.  *  He 
made  inflammation  to  depend  upon  stagnation  of  the  blood  in 
the  vessels,  in  consequence  of  which  its  more  volatile  and  sub- 
tile parts  which  commonly  dilute  the  acid  or  alkaline  portions, 
evaporated ;  then  these  latter  became  more  acrid,  produced  a 
hot  effervescence,  because  of  the  oleaginous  molecules  they 
contained,  and  the  blood  might  in  this  way  arrive  at  such  a 
degree  of  inflammation  as  to  be  transformed  into  pus.t  These 
doctrines  and  this  language  are  scarcely  intelligible  to  us;  and 
yet,  amid  so  many  vain  hypotheses,  one  is  often  surprised  to 
find  from  time  to  time  propositions  which  deserve  a  serious 
examination,  and  to  which  pathological  physiology  has  of  late 
returned.  It  is  in  this  way  that  Sylvius  explains  a  consider- 
able number  of  disorders  of  the  digestive  functions,  sometimes 
by  the  unusual  chemical  reactions  which  take  place  in  the 
stomach  or  in  the  intestines,  sometimes  by  the  formation  in 
these  parts,  of  an  excess  of  acid,  sometimes,  on  the  contrary, 
by  the  diminution  of  the  acid  or  alkalinematerials  which  ought 
naturally  to  be  formed  in  the   digestive  tract.  J  Elsewhere, 

•  *  Quolibet  acre,  nunc  acidum,  nunc  lixivo-salsum,  nunc  muriatico-salsum, 
par  venas  una  cum  sanguine  ad  cor  propulsum,  atque  interne  cordis  paren- 
chyma mordicans.  Francisci  Sylvii  Deleboe  praxeos  medicEe  liber  primus, 
caput  xxvii.  de  Febribus  in  genere. 

•j-  Arbitror  autem  incendi  ac  inflammationem  parere  sangulnem,  quatenus 
ex  ipso  in  vasis  suis  vald6  distentis,  partibusve  quibusdam  aliis  subsis- 
tente,  hoc  est  stagnante,  mox  incipiunt  evanescere  partes  spirituosse,  ma- 
gisque  volatiles  ac  subtiles  turn  acidas,  turn  salinas  temperare  solitce  ;  unde 
utrscque  acriores  factce  acrius  in  se  mutuo  insurgunt,  effervescentiamque  ob 
partes  sanguinis  oleosas  prsesentes  calidam  excitant;  quin  paulatim  san- 
guinem  ita  corrumpunt,  ut  in  pus  vertatur.  Sylvius  Deleboe,  loc.  cit.,  lib.  i. 
cap.  xl. 

\  Idem,  ibid,  cap.  i,  de  siti  Isesa. — cap.  vii,  de  alimentorura  fermentatione  in 
ventriculo  laesa. — Cap.  ix,  de  nausea,  eructatione  et  vomitu. — Cap.  x,  de  chyli 
a  fcecibus  alvinis  secretione  Isesa. — Cap.  xi,  de  vitiosa  bills,  et  succi  pan- 
creatici  una  cum  pituita  continuo  excitatain  tenui  intestino  effervescentia. — 
Cap.  xiv,  de  variis  intestinorum  doloribus. 

Might  not  several  of  the  subjects  announced  in  these  titles  of  chapters  be- 


THE  BEST  METHOD  OF  STUDY".  21 

Sylvius  seeks  to  account  for  the  fluidity  of  the  blood  in  malig- 
nant fevers  and  in  the  plague,  by  the  presence  in  the  mass  of 
that  fluid,  of  an  excess  of  alkaline  principles,  formed  in  the 
economy,  or  introduced  from  the  exterior ;  and  what  occurs 
rarely  in  his  works,  he  cites  here  seven  experiments ;  he  says  on 
the  one  hand,  that  the  injection  of  acid  substances  into  the  veins 
of  a  living  animal  produces  instantly  coagulation  of  the  blood, 
and  on  the  other  hand,  that  the  blood  becomes  dissolved  on  the 
contrary,  when  the  injection  is  made  with  alkaline  substances.* 
These  facts  are  amongst  those  which  have  been  in  a  measure 
rediscovered  by  modern  observers :  and  M.  JNIagendie  has 
proved  that  by  efiecting  in  living  animals  a  true  dissolution  of 
the  blood,  by  means  of  an  alkaline  substance  mingled  with  it, 
we  produce  in  them  several  of  the  symptoms  that  belong  to 
typhus  fever.t  Such  was  this  Sylvius  Deleboe,  whose  opinions 
long  exercised  so  powerful  an  influence  on  the  theory  and 
practice  of  medicine;  a  truly  distinguished  man,  whom  the 
insufficient  light  of  chemistry  in  its  infancy,  and  of  an  imperfect 
method  *of  investigation,  led  to  the  most  singular  illusions,  but 
who  had  the  merit  of  discovering  some  truths,  of  foreseeing  a 
great  number,  and  of  forming  a  body  of  doctrine,  the  founda- 
tions of  which,  some  one  may  perhaps  seek  to  reconstruct  with 
more  solid  and  more  durable  materials.  It  may  be  that  I 
deceive  myself,  but  it  seems  to  me  that  while  meditating  on 
these  hypotheses  of  the  chemical  physicians  of  the  sixteenth 
century,  though  we  may  recognize  most  generally  their  futility, 
the  mind  is  nevertheless  arrested  and  returns  to  them,  as  though 
conscious  that  they  place  it  upon  a  point  of  view,  where  im- 
portant truths  are  about  to  be  disclosed  to  it. 

I  do  not  pretend  to  pass  in  review  the  numerous  authors 

come  material  for  interesting  works  1  this  it  is  which  attracts  so  strongly  to 
the  study  of  the  works  of  Sylvius,  and  of  many  other  of  his  contemporaries, 
though  we  feel  that  they  do  no  more  than  propose  problems  without  resolving 
them. 

♦  Sylvius  Deleboe,  praxis  medica,  lib.  i,  cap.  xxxiii,  de  febribus  malignis. — 
De  pesie,  sectio  iii. — Praxeos  medicae  appendix,  tractatus  ii. — De  methodo 
medendi,  lib.  ii,  cap.  xxvi. 

\  Magendie,  lejons  sur  les  phenomenes  physiques  de  la  vie,  passim. 


^* 


22  PATHOLOGICAL  HiEMATOLOGT. 

who,  before  or  after  Sylvius,  sought  hke  him  to  determine 
through  chemistry  the  seat  and  nature  of  diseases.  On  this 
hst  would  appear  the  most  illustrious  names,  such  as  those  of 
Van-Helmont,  of  Willis,  of  Boerhaave  and  of  his  commentator 
Van-Swieten:  so  natural  did  it  appear  to  these  men,  who 
followed  in  other  respects  such  different  doctrines,  to  bring 
into  play,  in  their  theories  of  disease,  the  consideration  of  the 
principles  which  the  chemistry  of  their  day  showed  to  exist  in 
the  human  body!* 

•  To  comprehend  these  authors,  we  must  not  deceive  ourselves  upon  the 
meaning  that  they  attached  to  the  word  so  often  repeated  by  them  of  ele- 
ments or  principles ;  here  is  the  signification  given  to  it  by  Willis,  (de  fer- 
mentatione,  cap.  1): 

"  Principiorum  nomine  intelligo  baud  entia  simplicissim,a  et  omnino  in- 
composita,  sed  tantum  substantias,  in  quas  veluti  partes  ultimo  sensibiles, 
res  physicge  resolvuntur.  Harum  combinatione  et  motu  intestino  corpora 
gignuntur  et  accrescunt;  harum  mutuo  ab  invicem  discessu  et  dissolutione 
alterantur  et  intereunt." 

But  besides,  the  chimiatric  doctrines  of  the  three  last  centurie^  would  be 
unintelligible  for  him  who  did  not  know,  that  in  the  language  of  those  times, 
the  expressions  by  which  were  designated  the  elements  of  the  bodies  then 
admitted,  had  a  sense  totally  ditferent  from  that  we  give  to  them  at  present. 
For  Sylvius,  for  Willis,  as  well  as  for  Paracelsus,  the  words  mercury,  sulphur, 
and  salt,  were  employed  in  a  sense  altogether  metaphorical,  as  may  be  seen 
by  the  following  passage  from  the  chemistry  of  Sylvius,  which  I  translate 
literally: 

Chemistry,  says  Sylvius,  is  nothing  more  than  the  separation  of  compound 
bodies  into  their  principles:  these  latter  are  five  in  number, to  wit:  mercury, 
sulphur,  salt,  phlegm,  and  earth. 

Mercury  is  the  name  given  by  chemists  to  spirit,  because,  like  mercury,  it 
is  volatile.  This  spirit  or  mercury  is  any  subtle  or  penetrating  liquor,  as  the 
spirit  of  rectified  wine,  or  the  spirit  of  salt  of  nitre.  We  call  that  also  spirit 
which  disengages  itself  from  bodies  in  a  state  of  fermentation,  but  we  ought 
more  particularly  to  confine  this  term  to  whatever  is  volatile  in  its  material, 
no  matter  what  may  be  its  origin.  In  this  way  we  find  three  spirits ;  an  in- 
sipid, a  sulphurous,  and  a  saline  one. 

Sulphur  is  whatever  is  inflammable;  it  is  sweet  or  bitter;  the  first  exists 
in  fat  and  in  flesh,  the  second  in  absynlhium  and  in  bile :  there  is  one  sul- 
phur which  is  volatile,  and  another  which  is  fixed. 

Salt  is  whatever  can  be  incinerated;  it  is  acrid,  sometimes  fixed  and  some- 
times volatile  ;  a  fixed  salt  is  one,  which  may  four  times  be  exposed  to  heat 
without  change ;  a  volatile  salt  is  one  which  when  exposed  to  a  slight  heat, 


THE  BEST  METHOD  OF  STUDY.  33 

Nevertheless,  even  during  their  greatest  development,  these 
doctrines  were  not  adopted  without  opposition ;  they  met  with 
numerous  and  able  opponents,  amongst  whom  we  find  a 
learned  natural  philosopher,  Robert  Boyle,*  and  a  celebrated 
observer,  Thomas  Sydenham.  The  first  brought  forward 
doubts  on  the  reality  of  the  existence  of  the  chemical  princi- 
ples admitted  by  his  contemporaries ;  he  demanded  that  they 
should  verify  by  experiment  so  many  gratuitous  assertions, 
and  in  this  way  made  a  wide  breach  in  the  applications  that 
had  been  made  of  them  in  medicine.  The  second  strongly 
opposed  the  physicians,  who  according  more,  said  he,  to  specu- 
lation,' than  to  practical  observation,  long  sought  to  explain 
diseases  by  the  new  inventions  of  the  qhemists  ;  he  accepted 
the  aid  of  chemistry  only  to  enlighten  physicians  in  the  pre- 
paration of  remedies.!  The  absolute  aversion,  manifested  by 
Sydenham  for  every  application  of  chemistry  to  medical  theo- 
ries, was  certainly  in  him  the  very  natural  result  of  the  im- 
pression that  had  been  made  upon  his  mind  by  the  hypothe- 
ses of  the  iatrochemists,  and  particularly  by  the  conclusions 
that  they  had  deduced  from  them  for  the  treatment  of  diseases, 
a  treatment  in  flagrant  opposition  to  that  the  power  of  which 

evaporates  and  is  dissipated  in  the  atmosphere,  or  which,  when  enclosed,  at- 
taches itself  to  the  sides  of  the  alembic  or  recipient. 

Phlegm  is  any  aqueous,  insipid  fluid,  that  is  unsusceptible  of  being  vola- 
tilized by  a  very  strong  fire. 

An  earth  is  a  gross,  dry  substance  which  has  no  other  quality  than  that  of 
remaining  in  this  latter  condition,  no  matter  to  what  test  we  submit  it. 

Of  these  five  elements,  ^the  three  first  are  called  active,  because  upoa 
them  depend  all  the  movements  of  natural  bodies ;  the  two  last  are  called 
passive,  because  they  do  not  act  in  themselves,  and  because  they  receive 
from  the  first  the  stations  they  must  occupy;  Paracelsus  and  others  refuse 
them  the  title  of  elements."     Sylvius  de  Leboe,  de  chymia  in  genere. 

•  Robert  Boyle,  the  sceptical  chemist,  1661. 

f  Et  sicuti  Hippocrates  eos  reprehendit,  qui  huic  in  humanis  corporibus 

speculandis  curiositati  plus  dant  quim  observationibus  praticis, it4 

pari  jure  prudens  vir  quispiam  in  hoc  nostro  seculo  eos  culpare  possit,  qui 
existimant  artem  medicans  nulla  re  ulla  magis  promoveri  posse  quim  novis 

chemicoruminventis at  si  intri  pharmacopise  limitescentineaturchimia, 

ars  est  satis  quidem  laudabilis. — {^Sydenham,  tractalus  de  hydrope.) 


24  PATHOLOGICAL  HEMATOLOGY. 

was  daily  proved  to  him  by  a  most  admirable  observation. 
Thus,  this  excellent  genius  was'  led  to  disown  and  deny  the 
truth  of  a  principle,  the  abuse  or  improper  application  of 
which  had  too  strongly  prejudiced  him.  More  recently  Bor- 
deu  reproduced  these  attacks  of  Sydenham  against  the  utility 
of  the  application  of  chemistry  to  pathogeny.*  In  this  way 
it  happened,  in  consequence  of  the  reaction  which  infal- 
libly occurs  against  the  best  principles  when  exaggerated,  that 
medicine,  which  for  two  centuries  had  drawn  most  of  its  theo- 
ries from  chemistry,  came  to  reject  in  an  absolute  manner  all 
aid  from  this  science,  excepting  for  pharmacology,  as  Syden- 
ham had  desired;  an  instrument  as  yet  imperfect  was  badly 
employed,  it  was  broken.  Nevertheless,  more  impartial  than 
Sydenham  or  Bordeu,  because  he  had  studied  more  fully, 
Haller,  while  assigning  limits  to  chemical  investigation,  pro- 
claimed it  as  necessary  to  the  progress  of  medical  doctrines; 
laying  aside  hypothesis,  he  noted  with  care,  in  his  great  phy- 
siology, the  results  of  the  few  experiments  that  had  been  made 
before  his  time  in  order  to  determine  the  normal  and  abnormal 
composition  of  the  blood ;  he  pointed  out  by  this  means  the 
true  method  to  be  pursued,  and  wrote  this  phrase  full  of  mean- 
ing :  Non  ideo  analyses  sanguinis  utilitate  sua  distituun- 
tur,  dum  sapienter  noverimus  spes  nostras  redder e,  neque 
plura  docere  quam  a  naturd  discimusA 

Such  were  the  fruits  of  the  iatrochemical  doctrines,  and  they 
existed  in  science  but  as  wrecks,  so  to  speak,  when  the  genius 
of  Lavoisier  arose,  to  give  to  chemistry  a  new  aspect,  and  im- 
part to  it  a  certainty  until  then  unknown.  Medicine  felt  its 
influence,  and  began  anew  to  search  for  the  cause  and  seat  of 
diseases  in  the  various  principles  which  a  wonderful  analysis 
had  just  revealed.  But  the  first  essays  of  this  kind  were  most  un- 
fortunate, for  they  had  also  for  support  merely  pure  hypotheses. 
While  adopting  the  words  of  Lavoisier's  chemistry,  physicians 
took  neither  its  spirit  nor  its  method,  and  continued  to  advance 

•  Bordeu,  analyse  medicinale  du  sang. 

f  Haller,  elementa  physiologiae,  lib.  v.  §  xxsiv. 


THE  BEST  METHOD  OF  STUDY.  25 

as  in  the  time  of  Paracelsus.  In  this  way  was  composed  the 
strange  nosography  published  by  Baumes,  in  wliich,  mider  the 
titles  of  calorineses,  oxigeneses,  hydrogeneses,  azoteneses  and 
phosphoren^ses,  the  professor  of  Montpellier,  divided  diseases 
into  five  classes,  giving  to  each  one  of  them  a  name  in  relation 
with  the  principle  or  element,  which  he  quite  gratuitously  sup- 
posed to  produce  them  by  its  modifications  of  quantity  or  sit- 
uation.* 

Ancient  chemistry  has  surely  produced  nothing  more  hypo- 
thetical or  more  extravagant  than  this  singular  classification 
of  diseases :  it  is  beside  an  imprudent,  altogether  conjectural 
application  of  chemical  knowledge  to  the  science  of  the  sick 
man.  If  this  method  had  been  persevered  in,  the  opinion  of 
Sydenham, '  and  Bordeu  would  certainly  have  triumphed ; 
happily  however  some  wise  spirits  perceived  all  that  was  un- 
reasonable and  dangerous  in  it.  A  few  years  after  the  disco- 
very of  pneumatic  chemistry,  two  chemists,  Parmentier  and 
Deyeux,  associated  themselves  for  the  purpose  of  discovering 
by  experiment,  to  what  extent  the  normal  principles  of  the 
blood  are  susceptible  of  change  in  disease ;  but  their  work 
rested  on  too  small  a  number  of  facts  to  permit  us  to  draw  any 
useful  conclusion  from  it,  and  it  therefore  passed  by  mmoticed ; 
no  one  at  that  period  pursued  the  excellent  method:  which 
they  had  just  pointed  out.t  On  the  other  hand,  the  spnit  of 
the  physical  sciences  which  began  to  be  introduced  into  medi- 
cine, caused  all  the  uncertainty  of  the  ancient  humorism  to  be 
felt:  they  thought  now  only  of  combating  and  destroying  it, 
and,  in  the  eagerness  of  the  reaction  which  followed,  soon 
arrived  at  denying  completely  that  the  blood  could,  by  its 
alterations,  play  a  part  m  the  production  of  disease.    The  ne- 

•  Baumes,  Fondements  de  la  science  methodiqae  des  maladies,  4  vol.  in  8**. 
Idem,  Traite  sur  la  vice  scrophukux,  disc.  prcUmin.  Idem,  Essai  d'un  systeme 
chimique  de  la  science  de  I'homme,  Nismes,  1788. 

f  Memoir  on  the  blood,  in  which  the  following  question  is  answered:  to 
determine  by  modem  chemical  discoveries,  and  by  exact  experiment,  what  is 
the  nature  of  the  alteration  that  the  blood  undergoes  in  iniiammatory  diseases, 
in  putrid  febrile  diseases,  and  in  scurvy,  by  citizens  Parmentier  and  Deyeux. 
This  title  stated  the  problem  to  be  resolved  in  the  clearest  possible  manner. 
3 


26  PATHOLOGICAL  HiEMATOLOGY. 

cessary  consequence  of  this  doctrine,  was  the  neglect  of  all  ex- 
perimental research  as  to  the  alterations  of  the  blood,  to  which 
they  had  ceased  to  attach  the  least  importance.  Vainly  did 
Bichat  at  that  period  write  thus  in  his  general  anatomy ;  Hu- 
moral medicine  has  been  exaggerated  without  doubt ;  but  it 
has  solid  foundations,  and  in  a  number  of  cases  ive  cannot 
deny  that  all  should  be  referred  to  a  vice  of  the  humours* 
This  protest  from  a  man  of  genius  was  not  listened  to  by  his 
contemporaries,  and  if  it  had  been  they  probably  would  not  at 
that  time,  have  followed  the  proper  route  for  discovering  and 
demonstrating  this  vice  of  the  humours,  as  Bichat  expressed 
himself  in  language  borrowed  from  his  predecessors :  for  at 
that  epoch  the  most  absolute  contempt  was  generally  expressed 
for  the  application  of  chemistry  to  the  research  of  physiological 
and  pathological  facts. 

The  same  occurred  as  to  the  study  of  the  blood  by  the  mi- 
croscope, as  had  happened  as  to  its  study  by  chemistry. 

It  was  natural  indeed  that  a  short  time  after  the  discovery  of 
Leeuwenhoeck,men  should  endeavour  to  discover  what  became 
of  the  globules  of  the  blood  in  disease  ;  but  instead  of  devoting 
themselves  with  this  view  to  direct  observation,  they  still  pro- 
ceeded by  hypotheses ;  and,  as  they  had  explained  diseases 
by  alterations  that  they  supposed  to  occur  in  the  chemical  ele- 
ments of  the  blood,  in  the  same  way,  they  explained  them  by 
certain  alterations  which  they  imagined  quite  as  gratuitously 
to  occur  in  the  globules.  It  is  thus  that  the  celebrated  theory 
of  the  error  loci,  invented  by  Boerhaave,  by  which  he  ex- 
plained a  very  great  number  of  morbid  phenomena,  had  its 
point  of  departure  in  the  altogether  hypothetical  idea  of  the 
division  of  the  globules  into  others  much  smaller,  which  could 
normally  penetrate  only  into  vessels  whose  diameter  was 
proportioned  to  their  own.t  Another  author,  Huxham,  sup- 
posed that,  in  fever,  the  globules  became  altered  by  too  rapid 
a  movement;  he  supposed  beside  that,  in  diseases  called 

•  Anatomie  generale,  tome  1,  considerations  preliminaires. 
f  Van.  Swieten  commentar.  in  Harm.  Boeerhaavii  pphorismos,  t.  1,  p. 
]  43,  obstructio. 


THE  BEST  METHOD  OP  STUDr.  37 

putrid,  these  bodies  being  softened,  were  torn  and  broken 
into  small  portions,  which  entering  readily  into  the  smallest 
vascnlar  ramifications,  arrived  at  the  open  orifices  of  exhalent 
vessels,  and  were  thrown  out  externally;  in  this  way  Hux- 
ham  explained  the  hemorrhages  of  putrid  fever.*  Had  this 
author  then  seen  the  globules  thus  broken  and  reduced  to 
fragments  in  the  field  of  the  microscope  ?  By  no  means : 
but  he  supposes  by  a  pure  intuition  of  his  mind  that  it  ought 
to  be  thus,  and  does  not  trouble  himself  to  give  the  slightest 
experimental  proof  of  so  grave  an  assertion.  If  Huxham 
had  examined  with  the  microscope  the  blood  of  a  patient  la- 
bouring under  putrid  fever,  he  would  soon  have  discovered 
how  little  foundation  there  was  for  his  opinion ;  for  he  would 
have  found  the  globules  neither  torn  nor  broken,  and  would 
have  been  compelled  to  renounce  his  explanation  of  hemor- 
rhages. But  just  as  we  have  seen  the  good  sense  of  the  pub- 
lic finally  render  justice  to  the  hypotheses  of  iatrochemistry, 
so  the  time  at  length  arrived  when  all  the  vanity  of  these  sys- 
tems erected  in  consequence  of  the  facts  discovered  by  the 
microscope  was  to  be  recognized.  Then  it  was  that  Bordeu 
attacked  with  bitter  irony  those  authors  who,  said  he,  iveiit  so 
far  as  to  see  or  imagine  the  globules  bursting  and  falling 
to  pieces,  like  so  mani/  globules  of  glass  ;  but  sensible  people, 
he  adds,  will  care  little  for  such  puerilities.  All  these  vain 
theories  disappeared  then,  but  with  them  unfortunately  were 
dragged  into  oblivion  the  facts  so  full  of  interest  and  of  pro- 
mise upon  which  they  had  rested  for  half  a  century.  Physi- 
ology and  pathology  rejected  as  useless,  or  dreaded  as  a  source 
of  error,  the  employment  of  the  microscope;  and  this  instru- 
ment was  completely  abandoned,  as  chemistry  had  been  before 
it.  The  glory  of  returning  by  the  experimental  method,  to  the 
microscopic,  as  it.  has  done  to  the  chemical  study  of  the  blood, 
was  reserved  for  our  epoch. 

Thus,  by  turns  abandoned  and  resumed,  the  idea  of  seek- 
ing the  origin  of  disease  in  some  change  of  proportion  or  of 

•  Essai  sur  les  fievres,  par  Jean  Huxham,  traduction  Fran§aise,  1  vol.  in 
12,  p.  3  et  suiv.,  p.  68  et  suiv. 


28  PATHOLOGICAL  HEMATOLOGY. 

nature  that  the  elements  of  organized  bodies  may  have  under- 
gone, has  advanced  with  various  fortune  from  the  origin  of 
science  down  to  our  days;  it  has  more  or  less  swayed  the 
mind  first  by  the  ancient  doctrine  of  the  elements,  then  by  iatro- 
chemistry  and  by  the  microscopic  researches  of  the  three  last 
centuries,  and  finally  by  the  applications  that  have  been  made 
in  medicine  of  the  discoveries  of  pneumatic  chemistry.  And 
if,  notwithstanding  the  many  fallacies  to  which  it  has  led,  this 
idea  has  never  been  forgotten,  if  at  periods  the  most  diverse, 
and  in  spite  of  the  falsity  of  the  doctrines  which  have  often 
been  its  fruit,  it  has  continued  to  seduce  and  attract  the  most 
eminent  men,  this  depends  in  my  opinion,  upon  the  fact  that 
it  contains  an  important  truth,  to  wit,  that  one  of  the  possible 
causes  of  disease,  is  some  change  of  relation  or  proportion, 
which  the  elementary  principles  that  compose  organized 
bodies  under  their  two  forms  of  solid  and  liquid,  are  suscepti- 
ble of  undergoing.  Thanks  to  the  progress  of  organic  chemis- 
try, the  moment  seems  to  have  arrived  when  more  than  ever 
we  may  hope  to  place  this  truth  in  its  full  light,  by  the  rigorous 
employment  of  experimental  methods;  and  it  would  afford 
proof  of  a  culpable  ignorance,  or  of  a  dangerous  scepticism,  to 
refuse  to  accept  the  results  of  the  chemical  science  of  our  day, 
because  those  yielded  by  another,  which  had  nothing  in  com- 
mon with  it  but  the  name,  had  been  convicted  of  insufficiency 
or  of  error. 

But  in  order  that  chemical  and  microscopic  analysis,  applied 
to  the  study  of  the  blood  in  disease,  may  yield  results  really 
useful,  one  condition  is  indispensable  :  which  is,  to  acquire  pre- 
viously V  n  accurate  knowledge  of  all  the  varieties  of  the  phy- 
siological condition  of  the  blood.  For  want  of  sufficient  ac- 
quaintance with  all  the  diversities  of  aspect  and  composition 
that  the  blood  may  present,  without  health  being  interfered 
with,  we  might  commit  continual  errors,  as  I  am  about  to  show 
by  some  examples. 

And  first  of  ah  we  must  not  infer  the  composition  of  the 
blood  of  one  species  of  animal  by  that  of  another.  I  have 
shown  in  the  memoir  published  upon  this  subject  in  connec- 


THE  BEST  METHOD  OF  STUDY.  29 

tion  with  MM.  Gavarret  and  Delafond,  the  very  remarkable 
diiFerences  which  exist  in  this  respect  in  the  various  species  of 
animals.  We  have  proved  in  that  work,  that  there  are  some 
classes  whose  blood  contains  more  than  double  as  much  fibrine 
as  that  of  others,  and  that  these  differences  exist  also  for  the 
globules.  To  what  false  results  then  should  we  not  aiTive, 
were  we  to  take  as  our  point  of  departure  in  diseased  animals, 
the  physiological  proportions  of  the  globules  and  fibrine  of 
man,  in  order  to  calculate  the  changes  of  composition  that  the 
blood  may  have  undergone  in  these  animals,  as  a  consequence 
of  disease. 

Neither  is  the  healthy  appearance  of  the  blood  the  same  in 
different  classes  of  animals,  and  that  appearance  of  this  fluid 
which,  in  man,  is  the  certain  expression  of  a  morbid  condition, 
belongs  to  other  beings  in  their  physiological  state  :  such  is  the 
case,  for  example,  in  regard  to  the  buffed  condition  of  the 
blood.  In  man,  whenever  a  true  buff,  such  as  I  shall  describe 
farther  on,  occupies  the  upper  portion  of  the  clot,  we  may  with 
certainty  affirm  the  existence  of  a  state  of  disease  ;*  and,  what- 
ever may  have  been  said  about  it,  this  buff  never  exists  in 
man  in  a  state  of  health.  But  mark !  it  is  not  the  same  in 
other  animals,  for  this  assertion  would  not  be  tenable  with 
respect  to  them.  Thus,  whenever  we  bleed  a  horse,  and 
manage  so  that  the  blood  flows  in  a  continuous  stream  with  a 
pretty  strong  jet,  into  a  vessel  neither  too  large  nor  too  flat,  we 
constantly  observe  the  upper  part  of  the  clot  occupied  by  a 
white  mass,  which  resembles  perfectly  the  buff  of  human 
blood.  This  was  shown  to  me  by  the  observations  that  I 
made  at  Alfort  with  MM.  Gavarret  and  Delafond.  This 
colourless  mass  constitutes  a  considerable  portion  of  the  clot ; 
in  regarding  it,  one  would  take  it  for  the  perfect  inflaimnatory 

•  We  must  distinguish  between  the  true  buff  of  the  blood,  and  those  trans- 
parent pellicles,  or  irisations,  which  have  not  the  same  meaning,  and  which 
may  be  found  on  the  upper  surface  of  the  clot  in  the  most  diverse  conditions 
of  health  and  of  disease.  I  have  shown  elsewhere  (Reponse  aux  objections 
dirig^es  contre  les  analyses  du  sang,  etc.)  the  causes  which  produce  these 
discolorations  of  the  clot. 

3* 


'*• 


®6  PATHOLOGICAL  HEMATOLOGY. 

buif  found  in  a  man  labouring  under  intense  pneumonia,  or 
acute  articular  rheumatism.  Why  then  does  the  buff  belong 
to  the  physiological  condition  of  the  blood  of  the  horse  ?  I 
shall  endeavour  after  a  while  to  give  the  reason. 

In  different  individuals  of  the  same  species,  supposed  always 
to  be  in  a  healthy  condition,  the  different  elements  of  the  blood 
may  present  variations  in  their  quantity,  which  however  al- 
ways remain  within  certain  limits.  There  results  from  this, 
for  each  of  these  elements,  a  maximum  and  a  minimum  above 
and  below  which  the  physiological  condition  can  no  longer 
exist,  while  that  condition  is  compatible  with  this  maximum 
and  minimum,  as  well  as  with  all  the  intermediate  propor- 
tions. 

The  average  of  the  fibrine,  in  human  blood,  is  in  the  phy- 
siological condition,  two-  I  have  shown  elsewhere  that  the 
value  of  this  proportion  could  not  be  impaired  by  other  num- 
bers that  have  been  given  by  some  experimentalists  as  repre- 
senting the  normal  quantity  of  the  fibrine  of  the  blood.  (See 
answer  to  objections  brought  against  the  analysis  of  the  blood, 
etc.)  In  healthy  individuals,  the  fibrine  may  vibrate  about 
this  average,  so  as  to  fall  to  the  proportion  of  2.5,  or  to  rise  to 
the  proportion  3.5,  without  the  physiological  state  being  there- 
by destroyed.  There  are  some  persons  even,  who,  without 
being  sick,  may  have  in  their  blood  nearly  4  in  fibrine,  or  in 
whom  this  element  may  fall  as  low  as  2.  But  these  are,  we 
must  admit,  maxima  and  minima  very  rarely  compatible  with 
the  physiological  condition ;  they  should  be  regarded  as  a  kind 
of  exceptional  proportions  which  belong  only  to  true  idiosyn- 
crasies. 

In  taking  the  proportion  -iVVo  ^s  that  which  represents  the 
average  of  the  globules  in  human  blood,  we  find,  in  the  phy- 
siological condition,  as  the  maximum  of  the  globules  the  pro- 
portion 140,  and  as  minimum  the  proportion  110.  But  this 
maximum  140  is  linked  with  the  plethoric  condition,  which, 
by  development  becomes  a  true  morbid  state.  Force  of  con- 
stitution is  the  condition  of  the  economy  which  most  contributes 
to  raise  the  globules  towards  their  maximum,  while  congeni- 


THE  BEST  METHOD  OP  STUDY.  31 

tal  or  acquired  debility  is  that  which  lowers  them  towards 
the  minimum. 

The  solid  materials  of  the  serum,  which  are  composed  almost 
exclusively  of  albumen,  present,  above  and  below  their  mean 
80,*  a  certain  number  of  proportions  which  are  equally  com- 
patible Avith  the  preservation  of  health ;  but  there  is  likewise 
for  these  materials,  and  consequently  for  the  albumen  a  certain 
degree  of  diminution  which  I  have  never  met  with,  without 
their  being  at  the  same  time  disease. 

Independently  of  the  individual  constitutions  which  intro- 
duce into  these  proportions  the  variations  that  I  have  just  sig- 
nalized, there  are  still,  independent  of  disease,  some  circum- 
stances which  may  equally  cause  these  proportions  to  rise  or 
to  fall,  without  our  being  able  to  accuse  therefrom  any  disease. 
Thus  I  have  shown  in  my  first  memoir  that  emissions  of  blood 
and  the  deprivation  of  aliment  have  for  constant  eifect  to  di- 
minish the  amount  of  the  globules,  while  the  fibrine  is  much 
less  rapidly  and  necessarily  influenced  in  this  way.  I  have 
begun  some  experiments  Avith  a  view  to  determine  to  what 
point  we  may  succeed  in  modifying  the  proportion  of  the  va- 
rious elements  of  the  blood,  by  giving  to  animals  a  more  or 
less  substantial  nutriment.  These  experiments  are  not  yet 
sufficiently  advanced  to  enable  me  to  make  known  positively 
the  results :  they  will  be  published  in  a  subsequent  work,  but 
I  have  thought  proper  to  mention  them  here,  as  entering  into 
the  general  plan  of  the  researclies  in  which  I  am  engaged. 

Happen  what  may,  what  I  have  just  said  suffices  to  show 
how  important  it  is  to  have  determined  with  some  rigour,  for 
the  physiological  condition,  the  possible  variations  of  quantity 
that  the  different  elements  of  the  blood  may  present,  before 
pursuing  these  analyses  in  the  pathological  condition. 

The  same  is  true  in  regard  to  the  microscopic  examination 

•  Pure  albumen  constitutes  of  this  mean  about  68  or  70.  When,  in  the 
following  portion  of  this  work,  I  mention  this  principle,  I  refer  to  pure  albu- 
men, separated  from  the  organic  and  inorganic  elements  to  which  it  is  united 
in  the  serum ;  in  case  this  separation  have  not  been  made,  I  shall  employ 
the  expression  of  solid  materials  of  the  serum. 


3-3  PATHOLOGICAL  H^MATOLOGr. 

of  the  blood.  This  examination  should  be  made  with  much 
time  and  care  for  healthy  blood,  before  we  think  of  studying 
by  the  microscope  the  changes  which  this  fluid  may  have 
undergone. 

It  is  for  want  of  having  engaged  in  this  preliminary  exami- 
nation of  the  physiological  condition,  that  so  many  erroneous 
assertions  have  been  emitted  upon  the  changes  that  the  condi- 
tion of  disease  may  produce- in  the  globules.  I  do  not  fear  to 
affirm  that  up  to  the  present  time,  no  one  has  observed  in  a 
positive  manner  any  alteration  of  form  or  texture  in  these  little 
bodies,  which  can  be  regarded  as  the  resuh  of  a  diseased  influ- 
ence, and  that  all  their  modifications  of  appearance  which  have 
been  described,  and  others  which  have  been  less  dwelt  upon, 
result,  some  from  the  progressive  destruction  that  they  have 
undergone  in  proportion  to  the  length  of  time  that  they  have 
been  removed  from  the  influence  of  vitality,  and  others  from 
some  circumstances  altogether  peculiar,  which  act  upon  them, 
but  which  are  not  circumstances  of  disease.  These  circum- 
stances have  not,  in  my  opinion,  been  properly  appreciated  : 
some  have  considered,  for  example,  as  an  indication  of  the 
destruction  of  the  globules,  that  granular  or  raspberjy-like 
appearance  which  we  so  often  find,  sometimes  in  the  blood  of 
subjects,  and  sometimes  even  in  the  recent  fluid,  examined 
shortly  after  it  has  been  extracted  from  a  living  vessel.  The 
researches  in  which  I  have  been  engaged  upon  this  subject,  do 
not  allow  me  to  accept  this  opinion.  The  globules  which 
assume  the  raspberry-like  appearance  have  not  been  changed 
by  disease,  nor  are  they  globules  in  one  of  the  phases  of  their 
period  of  destruction. 

When  we  place  in  the  field  of  the  microscope,  between  two 
pieces  of  glass,  a  drop  of  blood  immediately  upon  its  escape 
from  the  vessel,  we  readily  perceive  near  the  globules  properly 
so  called,  rounded,  white  corpuscles,  j^^  of  a  millimetre  in 
diameter,  the  existence  of  which  has  been  proved  by  all 
observers.  The  red  globules,  which  are  at  first  perfectly  regu- 
lar, with  abruptly  terminated  outlines,  soon  become  changed 
in  their  exterior  shape.     Some  present  upon  their  surfaces,  one, 


/• 


»  THE  BEST  METHOD  OF  STUDY.  33 

two,  or  three  little  protuberances,  and  are  called  raspberry-like  ; 
others,  resembling  iron  cog-wheels,  seem  regularly  festooned 
and  cut  upon  their  edges.  So  long  as  the  desiccation  of  the 
drop  of  blood  is  not  complete,  the  number  of  red  globules  thus 
deformed  augments  in  proportion  to  the  length  of  time  from 
the  commencement  of  the  experiment.  As  to  the  white  cor- 
puscles, tliey  become  more  rare  as  the  preceding  alteration 
advances  and  becomes  general. 

The  rapidity  of  formation  of  the  kind  of  nipples  or  protu- 
berances which  stud  the  red  globules,  and  the  important  fact 
that  their  exterior  aspect  and  dimensions  are  absolutely  the 
same  as  those  of  the  white  corpuscles,  all  led  me  to  think  that 
this  deterioration  of  the  globules  was  due  to  a  simple  attach- 
ment of  the  white  corpuscles  which  surrounded  them.  By 
following  attentively  all  the  movements  of  displacement  which 
occur  in  the  field  of  the  microscope,  I  have  been  enabled  to 
witness  the  production  of  the  phenomena,  to  see  the  white 
corpuscles  approach  the  red  globules,  dispose  themselves  upon 
their  surfaces,  adhere  to  their  edges,  and  in  this  way  to  form 
every  possible  variety  of  the  raspberry-like  and  festooned 
globules.  This  mamelonated  appearance,  which  some  have 
regarded  as  the  commencement  of  their  destruction,  and  others 
as  the  result  of  a  pathological  influence,  is  but  the  result  when 
strictly  examined  of  the  precipitation  of  the  white  corpuscles 
upon  and  aromid  the  red  globules. 

But  what  is  the  nature  of  these  white  corpuscles?  Here  a 
general  fact  is  about  to  appear.  Whenever  we  examine  blood 
as  it  escapes  from  the  vessels,  we  establish  first  the  presence  of 
isolated  white  corpuscles,  and  afterwards  the  raspberry-like 
and  festooned  appearance  of  a  certain  number  of  red  globules. 
When,  on  the  contrary,  we,  in  any  way,  deprive  the  blood  of 
all  its  fibrine,  before  spontaneous  coagulation,  we  no  longer  find 
white  corpuscles  in  the  field  of  the  microscope,  and  the  red 
globules  present  neither  the  raspberry-like,  nor  the  festooned 
appearance.  When  left  a  long  time  to  themselves,  these  glo- 
bules, thus  separated  from  the  fibrine,  diminish  gradually  in 
size,  become  reduced  to  a  kind  of  central  nucleus,  and  finish 


34  PATHOLOGICAL  HEMATOLOGY.* 

by  disappearing  entirely,  but  in  no  case  are  either  their  sur- 
faces or  their  edges  studded  with  prominences.  The  presence 
offibrine  then  is  necessary  in  order  that  the  drop  of  blood  should 
contain  white  corpuscles,  and  without  these  the  alteration  of 
the  globules  is  not  produced. 

The  fibrine  may  likewise  be  studied  under  the  microscope 
before  it  has  spontaneously  concreted  into  thick  and  resisting 
membrane,  in  that  semT-transparent  and  seemingly  oleaginous 
layer,  known  under  the  name  of  liquid  buff,  which  constantly 
and  normally  forms  on  the  surface  of  blood  drawn  from  the 
horse,  and  only  in  well-determined  patl"tological  conditions  in 
man.  This  fluid  buff",  it  is  well  known,  is  nothing  more  than 
serum  holding  in  suspension  an  enormous  quantity  of  fibrine, 
and  this  latter  principle  presents  itself  in  the  form  of  white 
corpuscles  of  the  same  exterior  aspect  and  dimensions  as  those 
of  blood  not  deprived  of  fibrine.  In  order  to  study  the  fibrine 
before  its  complete  coagulation  with  yet  greater  ease,  it  is  only 
necessary  to  mix  .syme  blood  as  it  escapes  from  the  vein  with 
one-seventh  its  volume  of  a  saturated  solution  of  sulphate  of 
soda.  The  mixture  rapidly  divides  into  two  portions,  one  be- 
low consisting  of  perfectly  unaltered  globules;  the  other  above, 
formed  of  an  opaline  fluid,  where  the  whole  of  the  fibrine  is 
held  in  suspension,  under  the  form  of  white  corpuscles  ^^o^b  of 
a  millimetre  in  diameter,  as  in  the  fluid  buff.  The  solidifica- 
tion of  the  fibrine  goes  on  very  slowly,  and  one  can  readily 
trace  the  different  phases  througli  which  it  passes,  while  chang- 
ing from  the  liquid  to  the  solid  state. 

If  we  take  a  drop  of  blood  deprived  of  fibrine,  the  globules 
of  which  are  in  consequence  perfectly  pure,  and  can  no  longer 
undergo  the  change  known  under  the  name  of  the  raspberry- 
like and  festooned  appearance,  and  add  to  it  some  fibrine  in 
the  condition  of  corpuscles  prepared  with  the  sulphate  of  soda, 
or  taken  directly  from  the  fluid  buff",  we  see  reproduced  all  the 
phenomena  of  which  I  have  spoken,  in  regard  to  blood  not 
previously  deprived  of  its  spontaneously  coagulable  element. 

This  granted,  it  is  very  easy  to  understand  what  happens 
when  we  place  a  drop  of  blood  on  a  plate  of  glass,  and  blow 


THE  BEST  METHOD  OF  STUDY.  35 

Strongly  upon  it,  in  such  a  way  as  to  spread  it  out  into  an 
extremely  thin  layer.  If  the  operation  be  well  done  and  with 
rapidity,  the  globules  remain  perfectly  unchanged,  their  sur- 
faces are  smooth,  their  edges  very  cleanly  cut,  and  left  to 
themselves,  they  never  become  either  rasp  berry -like  or  fes- 
tooned. In  these  circumstances  the  evaporation  of  the  serum 
is  almost  instantaneous,  its  solidification,  so  to  speak,  imme- 
diate, aiKl  the  fibrine  has  not  time,  as  in  the  case  where  the 
blood  is  placed  between  two  plates  of  glass,  to  oscillate  about 
the  red  globules  under  the  form  of  white  corpuscles,  and  de- 
posit themselves  on  their  surfaces  and  edges.  Let  no  one 
object  that  the  raspberry-like  appearance  assumed  by  the 
globules  inclosed  between  two  glasses  depends  on  the  fact  of 
their  being  altered  by  the  compression  ;  for,  if  we  place  a  drop 
of  blood  entirely  deprived  of  fibrine  between  two  glasses,  we 
never  see  the  globules  become  surrounded  by  granulations. 
And  if  moreover  I  have  dilated  in  this  place  upon  such  a  sub- 
ject, it  is  in  order  to  show,  by  this  example  chosen  from  many 
others,  how  important  it  is  to  investigate  with  minuteness  all 
the  influences  that  can  take  from  the  globules  their  normal 
aspect,  before  considering  these  changes  as  the  product  of  a 
pathological  influence.  What  beside  more  diversified  than  aU 
the  variations  of  form  that  the  globules  may  take  from  their 
simple  contact,  or  than  the  figures  they  may  assume  by  their 
agglomeration,  without  our  being  able  to  accuse  disease  of 
having  given  origin  to  such  changes  ? 

When  we  shall  in  this  way  have  studied  sufficiently  all  the 
influences  which,  foreign  to  disease,  may  produce  in  the  blood 
changes  in  its  physical  properties,  in  its  chemical  composition, 
and  in  its  microscopic  constitution,  it  will  become  possible  to 
investigate  the  alterations  that  it  may  undergo,  in  these  differ- 
ent respects,  by  the  fact  even  of  disease.  It  is  of  this  that  I 
am  about  to  treat  in  the  following  chapter. 


36  PATHOLOGICAL  Ha^MATOLOGT. 


# 


CHAPTER  II. 

OP  THE  BLOOD  IN  DISEASES. 

I  HAVE  pointed  out  in  the  preceding  chapter,  the  methods 
which  it  is  most  convenient  to  follow,  and  tlie  preUminary 
researches  to  which  it  is  indispensable  to  attend,  in  order  to 
study  with  advantage  the  alterations  that  the  blood  is  suscep- 
tible of  undergoing  in  diseases. 

The  alterations  that  chemical  analysis  and  microscopic 
examination  enable  us  to  trace  in  the  blood  ought,  it  seems  to 
me,  to  be  divided  into  three  great  classes. 

In  a  first  class,  I  range  the  alterations  of  the  blood  which 
result  from  the  fact  that  the  principles  which  enter  normally 
into  the  composition  of  that  fluid  do  not  exist  there  in  the  pro- 
portion compatible  with  the  physiological  condition. 

The  normal  elements  of  the  blood,  in  which  the  present  state 
of  our  knowledge  enables  us  to  trace  these  changes  of  propor- 
tion, are  the  globules,  the  fibrine,  the  albumen  of  the  serum, 
the  different  organic  materials  other  than  the  albumen,  which 
are  found  in  the  serum,  (fatty  matter  and  others,)  then  the 
inorganic  principles  contained  in  the  blood,  and  in  particular 
the  free  alkali  which  it  contains,  its  different  salts,  and  its 
water. 

But  this  is  not  all;  and  here  the  idea  presents  itself  of  in- 
quiring whether  disease,  in  some  of  its  manifestations,  may 
not  have  the  power  of  rendering  more  abundant,  and  conse- 
quently more  appreciable  by  analysis,  certain  materials  of  the 
secretions  which  we  may  suppose  to  exist  naturally  in  the 
blood,  but  in  too  small  quantity  to  make  it  possible  for  us  to 
discover  them  in  its  normal  condition.  Disease  would  furnish 
then  the  means  of  recognizing  them,  by  increasing  their  pro- 
portion, as  it  sometimes  makes  more  apparent  also  certain 
tissues,  by  causing  them  to  emerge  from  their  rudimentary  state. 


OP  THE  BLOOD  IN  DISEASES.  37 

Microscopic  researches  should  not  often  be  employed  in  the 
study  of  this  first  class  of  alterations ;  it  is  not  indeed  by  such 
means,  as  some  persons  have  supposed,  that  we  can  even  de- 
termine an  augmentation  or  diminution  of  the  number  of  glo- 
bules. 

Without  being  changed  in  quantity,  the  normal  principles  of 
the  blood  may  become  modified  in  relation  to  their  size  and 
their  physical  properties.  The  microscope  may,  for  example, 
disclose  diflerences  in  the  volume  or  in  the  form  of  the  globules, 
etc.     Here  we  have  a  second  class  of  alterations. 

Finally  it  may  happen,  that  in  the  place  of,  or  in  connection 
with  the  normal  elements  of  the  blood,  there  may  be  formed 
new  principles  which  have  no  analogues  in  the  healthy  condi- 
tion, and  which  may  be  compared  in  that  fluid  to  what  the 
accidental  formations  are  in  the  solids.  Here  then  is  a  third 
class  of  alterations  of  the  blood,  for  the  discovery  of  which 
should  co-operate  both  chemical  and  microscopic  researches. 
It  is  the  microscope,  for  example,  which  will  reveal  to  us  the 
presence  of  pus  in  the  blood,  etc. 

I  am  as  yet  far  from  being  able  to  trace  a  history  even  in- 
correct, of  all  these  alterations ;  but  such  is  the  circle  which  I 
have  determined  to  pursue,  by  following  out  the  modes  of  in- 
vestigation, whose  value  I  have  estimated  in  the  preceding 
chapter. 

It  was  proper  for  me  to  commence  with  the  study  of  the 
alterations  comprised  in  the  first  class ;  and  in  this  class,  the 
normal  elements  of  the  blood,  whose  changes  of  proportion  in 
diseases  I  have  sought  to  appreciate,  are  still  only  the  globules, 
the  fibrine,  the  solid  matters*  of  the  serum,  and  the  water.  I 
am  about  to  exhibit,  in  the  following  articles,  the  results  that  I 
have  obtained,  and  I  shall  strive  to  show  how,  in  each  disease, 
the  changes  of  proportion  that  the  blood  may  have  undergone 

*  In  the  memoirs  which  I  have  already  published,  I  had  estimated  in  mass 
the  quantity  of  these  sohd  materials.  More  recently  I  have  endeavoured  to 
separate  them  one  from  the  other,  so  that  I  might  indicate  with  greater  pre- 
cision for  certain  cases,  the  variations  in  proportion  of  the  albumen  properly 
so  called,  contained  in  the  serum. 
4 


38  PATHOLOGICAL  HiEMATOLOGT. 

in  its  physical  properties  are  in  relation  to  its  changes  of  com- 
position, and  are  explicable  by  them. 

Besides,  the  analysis  of  the  blood  in  the  diseased  condition 
reveals  such  great  differences  in  the  composition  of  this  fluid, 
that  it  is  difficult  not  to  admit  a  priori  that  changes  so  re- 
markable in  the  relative  or  absolute  proportion  of  its  consti- 
tuent principles  must  exercise  a  strong  influence  upon  the 
organism,  and  intervene  as  cause  in  the  production  of  a  more 
or  less  considerable  number  of  diseases.  When  for  example, 
we  see  in  the  morbid  condition  that  the  composition  of  the 
blood,  varies  to  such  an  extent  that  instead  of  a  thousand  parts, 
there  may  be  only  seventy -five  of  solids,  or  even  only  seventy, 
we  cannot  understand  that  so  enormous  a  difference  in  the 
quantity  of  the  elements  held  in  suspension  or  in  solution  in 
the  water  of  the  serum  should  not  be  taken  into  serious  con- 
sideration in  pathogenic  theories.  This  it  is  which  I  shall 
endeavour  to  bring  out  in  what  is  about  to  follow. 

I  shall  begin  by  showing  what  are  the  modifications  pro- 
duced in  the  composition  of  the  blood  by  two  states  of  the 
organism,  which,  when  to  slight  extent  may  still  coincide  with 
health ;  which,  when  to  a  greater  extent,  cease  to  belong  to 
the  physiological  condition,  and  which,  in  a  great  number  of 
cases,  complicate  diseases  and  modify  their  symptoms.  These 
two  states  are  on  the  one  hand  plethora,  and  on  the  other 
auccmia. 


ARTICLE  I. 

Of  the  Blood  in  Plethora. 

True  plethora  is  more  frequently  constitutional  than  ac- 
quired :  we  cannot  always  create  it  at  will  by  the  use  of  a 
very  substantial  aliment.  It  is  not  sufficient,  in  order  to  pro- 
duce it,  that  an  individual  shall  introduce  daily  into  his  di- 
gestive organs,  a  large  quantity  of  reparative  material,  and  that 


OF  THE  BLOOD  IN  DISEASES.  39 

he  shall  expend  very  little.  Plethora  seems  to  depend  often 
upon  a  primordial  constitution  of  the  blood,  which  it  is  im- 
possible for  us  to  produce  so  readily  as  we  can  produce  anae- 
mia, that  is  to  say,  in  other  words,  that  it  is  much  more 
in  our  power  to  impoverish  the  blood  than  to  increase  its  rich- 
ness. 

,  In  plethora,  as  in  anaemia,  the  peculiar  state  of  the  blood  is 
the  appreciable  cause  of  the  general  modification  which  the 
organism  presents.  This  is  for  us  at  least  the  primitive  fact 
beyond  which  we  cannot  go,  and  to  which  we  have  the  right 
to  refer  all  the  others.  Beyond  a  doubt  some  forces  have 
been  in  action  in  the  naturally  plethoric  or  anaemic  individual, 
from  the  commencement  of  the  formation  of  the  being,  which 
have  impresssed  upon  the  blood  a  certain  constitution  that  it  is 
ordained  to  preserve  ;  but  this  constitution,  once  produced,  does 
not  the  less  remain  the  single  demonstrable  fact,  the  only  one 
that  observation  can  seize  upon,  in  order  to  make  of  it  the  ex- 
perimental cause  of  the  phenomena. 

But  are  the  limits  of  the  science  established  when  it  has 
been  said  in  a  general  manner  that  the  blood  is  abmidant  and 
rich  in  plethora,  that  it  is  thin  and  impoverished  in  angemia  ? — 
This  question  it  is  important  to  examine,  and  I  proceed  by 
turns  to  occupy  myself  in  resolving  it  for  both  of  these  condi- 
tions. 

The  most  accredited  opinion  relative  to  the  state  of  the  blood 
in  plethora,  is,  that  it  fills  the  vessels  in  very  large  quantity, 
that  its  different  organic  elements  have  become  more  abun- 
dant, and  that  it  is  in  particular  richer  in  fibrine. 

Let  us  examine  one  after  another  these  different  assertions. 

It  is  impossible  to  demonstrate  the  augmentation  in  quan- 
tity of  the  blood  in  plethora — how  estimate  in  reality  what 
is  in  weight  or  in  volume  the  mass  of  fluid  contained  in  the 
vessels  ? 

But  if  we  cannot  arrive  at  this  valuation,  and  if,  in  conse- 
quence, we  are  compelled  to  acknowledge  our  ignorance  as  to 
whether  plethoric  persons  have  in  their  circulatory  apparatus 


40  PATHOLOGICAL  HEMATOLOGY. 

more  or  less  blood  than  other  individuals,  we  can  seek  to  deter-  . 
mine  whether  the  blood  of  such  persons  has  not  a  peculiar 
constitution.     Now,  with  respect  to  this,  here  is  what  analy- 
sis has  taught  me : 

It  has  shown  me  in  the  first  place  that  it  is  not  true  that, 
in  plethora,  the  blood  contains  very  much  more  fibrine  than 
in  any  other  condition ;  I  have  found,  in  reality,  2,7  of  fibrine,^ 
as  the  average  of  this  principle,  in  thirty-one  bleedings  per- 
formed upon  individuals  in  whom  the  plethora  was  fully  cha- 
racterized. Some  presented  as  yet  no  marked  symptoms  :  in 
them  the  bleedings  were  simple  measures  of  precaution ;  in 
the  others,  were  observed  vertigo,  tinnitus  aurium,  palpitations 
of  the  heart,  excessive  difficulty  of  respiration,  an  injection  as 
though  apoplectic  of  the  conjunctivae  of  the  eyes,  and  of  the 
face,  etc.  Thus,  in  these  individuals,  the  fibrine  did  not  even 
quite  equal  the  physiological  mean.  The  symptoms  of  ple- 
thora do  not  depend  then,  as  has  often  been  repeated,  upon 
an  augmentation  of  fibrine  in  the  blood.  Consequently,  in  the 
point  of  view  of  the  composition  of  the  blood,  plethoric  indi- 
viduals should  not  be  more  disposed  than  others  to  contract 
inflammations,  and  I  do  not  fear  to  affirm  that,  if  clinical  facts 
be  interrogated  as  to  this,  they  will  lead  to  the  same  conclu- 
sion ;  it  is  but  a  false  analogy  of  symptoms  which  has  caused 
it  to  be  said  that  plethora  disposed  to  the  phlegmasias.  The 
results  yielded  by  the  analysis  of  the  blood  are  found  here  to 
be  in  perfect  accordance  with  those  to  which  clinical  observa- 
tion conducts. 

The  fibrine  does  not  then  sensibly  augment  in  plethora ;  it 
remains  within  the  hmits  of  its  physiological  state,  and  does 
not  even  tend,  in  the  greater  number  of  cases,  to  mount,  to- 
wards the  higher  limit  of  this  state. 

The  organic  materials  of  the  serum  do  not  offer  either,  in 
plethora,  any  remarkable  change  of  proportions. 

The  globules  alone  remain,  and  it  is  effectively  the  great  ele- 
vation of  their  proportion  which  establishes  in  the  blood  the 
character  of  plethora;  in  the  31  bleedings  to  which  I  have 


OP  THE  BLOOD  IN  DISEASES.  41 

already  referred,  I  found  for  the  mean  of  the  globules  the  cipher 
141 ;  for  minimum,  131 ;  and  for  maximum,  154. 

The  blood  of  plethoric  persons  then  differs  from  ordinary- 
blood  in  the  greater  quantity  of  globules  and  the  much  less 
quantity  of  water  that  it  contains. 

The  physical  properties  of  this  blood  may  be  perfectly  ex- 
plained by  the  nature  of  the  changes  that  it  has  undergone  in 
its  composition. 

Thus,  before  coagulation,  the  blood  of  plethoric  people  is 
remarkable  for  its  high  coloration,  which  is  in  relation  with 
the  large  proportion  of  globules  it  contains. 

When  we  examine  it  after  coagulation,  we  observe  gene- 
rally that  the  serum  is  more  or  less  coloured,  that  the  clot  is 
large,  voluminous,  of  moderate  firmness,  and  that  it  retains  a 
large  quantity  of  serum ;  we  never  find  any  bufi"  upon  its  sur- 
face ;  at  most  we  may  sometimes  observe  there  a  thin  and 
transparent  pellicle,  or  some  scattered  irisations,  if  the  blood 
has  flowed  very  rapidly  from  the  vein. 

The  considerable  volume  of  the  clot  depends  manifestly 
upon  the  large  number  of  globules,  and  its  softness,  as  well  as 
the  constant  absence  of  the  buff,  depends  upon  the  small  pro- 
portion of  the  fibrine  relatively  to  that  of  the  globules. 

The  excess  of  globules  in  the  blood  of  plethoric  people  coin- 
cides in  them  with  a  certain  modification  of  the  physiological 
state,  and  also  with  a  certain  number  of  pathological  facts 
which  seem  to  be  a  consequence  of  it. 

Thus,  all  the  functions  are  usually  more  active,  and  there  is 
as  it  were  an  exuberance  of  life  :  digestion  proceeds  rapidly ; 
respiration  is  favoured  by  the  great  development  of  the  thora- 
cic cavity  ;  the  circulation  is  rapid,  the  heart  beats  with  force ; 
but  it  is  an  error  to  admit,  as  has  been  done,  that  in  such  cases, 
its  pulsations  may  be  accompanied  by  a  bellows-sound.  I 
myself  not  long  since  put  forth  this  opinion ;  but  a  more  at- 
tentive and  a  longer  observation  have  convinced  me  that  it  is 
not  so,  and  that  consequently,  in  those  cases  where  a  bellows- 
sound  had  been  heard  in  the  heart  or  arteries  of  plethoric 
patients,  it  is  because  the  diagnosis  had  been  badly  made 


43  PATHOLOGICAL  HEMATOLOGY. 

and  because  there  had  been  some  other  disease  with  the 
plethora. 

While  dwelling  on  all  these  modifications  of  functions  which 
coincide  with  the  plethoric  condition,  I  do  not  wish  to  repeat 
here  what  is  everywhere  known ;  it  was  only  necessary  for 
me  to  speak  of  them,  in  order  to  make  evident  their  coinci- 
dence with  the  fundamental  modification  that  the  blood  under- 
goes in  that 'condition,  to  wit,  an  augmentation  of  its  globules : 
however  I  will  remark  besides  the  peculiar  disposition  that  the 
brain  then  presents  to  become  excited,  the  facility  and  at  the 
same  time  the  mobiUty  of  the  emotions,  without  our  observ- 
ing at  the  same  time  those  exaggerations  or  those  aberrations 
of  sensibility,  and  those  nervous  predominances,  which  we 
shall  presently  find  to  accompany  almost  necessarily  an  oppo- 
site state  of  the  blood,  to  wit,  the  anormal  diminution  of  its 
globules. 

The  individuals  whose  blood  contains  an  excess  of  globules 
are  subject  to  some  peculiar  symptoms,  of  which  no  one  has 
perhaps  up  to  the  present  time  given  a  very  satisfactory  ex- 
planation ;  thus,  the  vertigo,  the  dizziness,  the  tinnitus  aurium, 
the  heat  of  head  that  they  experience,  have  been  accounted 
for  by  congestions  of  blood  towards  the  brain  ;  but  these  con- 
gestions have  never  been,  in  like  conditions,  anatomically 
proved,  and  the  mere  passage  of  an  excessive  quantity  of 
globules  through  the  vessels  of  the  brain  appears  to  me  a  fact 
sufficient  to  account  for  them ;  but,  singular  circumstance,  if  it 
happens  on  the  contrary  that  too  small  a  number  of  globules 
traverse  these  same  vessels,  analogous  symptoms  will  still 
present  themselves,  so  that  a  quantity  of  globules  either  too 
high  or  too  low  disturbs  in  the  same  way  certain  cerebral 
acts. 

An  excess  of  globules  in  the  blood  coincides  also  with  the 
more  frequent  and  more  ready  appearance  of  certain  hemor- 
rhages ;  I  shall  endeavour  further  on  to  give  an  explanation  of 
this. 

Finally,  in  these  cases  of  excess  of  the  globules,  it  is  not  un- 
common to  see  arise  by  intervals,  a  general  increase  of  excita- 


OP  THE  BLOOD  IN  DISEASES.  43 

bility  of  the  organism,  carried  to  such  a  point  that  a  true  fever 
may  be  the  consequence.  Vainly  should  we  seek,  in  order  to 
account  for  this,  any  alteration  of  the  solids  ;  they  do  not  pre- 
sent any,  and  the  fever  ought  then  to  be  considered  as  having 
its  point  of  departme  in  some  state  of  the  blood.  But,  let  us 
take  another  case :  suppose  that  coincidently  with  some  inflam- 
matory alteration  of  a  solid,  developed  in  an  individual  whose 
blood  contains  too  many  globules,  there  arises  fever ;  this  will 
then  present  a  physiognomy  altogether  peculiar ;  it  will  be 
remarkable  by  the  symptoms  of  high  reaction  which  shall  ac- 
company it ;  it  will  present  that  type  of  fever  called  by  Pinel 
angeiotenic;  and  this  type  will  depend  less  upon  the  seat  and 
nature  of  the  local  lesion,  than  on  the  condition  of  the  blood 
itself.  Venesection  will  certainly  modify  it,  by  acting  on  the 
blood,  whose  globules  it  will  infalliby  diminish ;  but  though 
evidently  useful  in  this  point  of  view,  it  Avill  have  a  much 
less  dhect  influence  on  the  inflammatory  alteration  which 
has  produced  the  fever  ;  for  this  alteration  is  connected  with 
another  modification  of  the  blood,  upon  which  bleeding  has 
much  less  direct  and  immediate  influence,  as  we  shall  see 
further  on. 

The  phenomena  of  plethora,  viewed  in  connection  with  the 
composition  of  the  blood  in  this  condition,  may  enlighten  us 
on  the  part  played  by  the  globules  of  the  blood  in  the  organ- 
ism. 


ARTICLE  II. 

Of  the  Blood  in  Jinxmia. 

I  HAVE  just  pointed  out  what  may  result  in  the  organism, 
in  the  state  of  health  and  of  disease,  from  an  excess  of  the 
globular  element  of  the  blood.  But  there  are  cases  also  in 
which  this  fluid  comes  to  present  a  character  precisely  inverse, 
that  is  to  say  when  its  amount  of  globules  falls  much  below 
the  physiological  mean,  and  diminishing  more  and  more, 


44  PATHOLOGICAL  HiEMATOLOGY. 

reaches  a  proportion  so  low  that  we  can  scarcely  comprehend 
how,  with  so  few  globules  in  the  blood,  life  can  still  be  main- 
tained. 

This  diminution,  in  different  degrees,  of  the  globular  ele- 
ment of  the  blood  is  the  fundamental  character  of  anaemia,  a 
condition  which,  therefore,  in  regard  to  the  composition  of  the 
sanguine  fluid,  as  well  as  in  relation  to  its  symptoms,  is  the 
opposite  of  plethora.  According  to  the  degree  of  the  diminu- 
tion of  the  globules,  this  condition  is  still  compatible  with  a 
certain  amount  of  health,  or  it  becomes  by  itself  a  true  morbid 
state,  which  may  exist  alone,  or  intervene  as  complication  in 
all  diseases.  Thus  then,  independent  of  the  solids,  we  find 
one  of  the  principles  of  the  blood,  becoming  distinct  from  all 
the  others,  exercising,  sometimes  by  its  augmentation,  and 
sometimes  by  its  spontaneous  diminution,  an  influence  such  as 
to  become  the  point  of  departure  and  the  sole  appreciable  ma- 
terial element  of  a  considerable  number  of  diseases. 

I  have  found,  as  the  average  of  the  proportion  of  the  glo- 
bules, in  16  cases  of  commencing  anaemia,  the  cipher  109,  and 
in  24  cases  of  confirmed  anasmia,  the  cipher  65.  I  have  con- 
structed these  averages  only  from  cases  of  spontaneous  anae- 
mia occurring  in  the  human  race ;  I  should  have  found  a 
lower  average  in  the  sheep  kind,  which  are  also  exposed  to 
become  anaemic,  and  which,  in  this  condition,  may  have  a 
blood  so  deficient  in  globules,  that  I  have  seen  one  of  them 
which  had  but  15  of  those  corpuscles  (see  Memoir,  etc.),  whilst 
in  the  human  race,  the  lowest  proportion  of  globules  that  I 
have  ever  met  with  in  spontaneous  anasmia  is  28.  It  is  true 
that  man  possesses  normally  in  his  blood  more  of  the  globules 
than  does  the  sheep  species ;  whence  it  follows  that,  propor- 
tionally to  the  physiological  condition,  the  minimum  28  of  glo- 
bules, found  in  the  spontaneous  anaemia  of  man,  is  very  nearly 
equal  to  the  minimum  15  found  in  ansemic  sheep. 

Besides,  it  is  necessary  to  distinguish  several  kinds  of  anae- 
mia, according  to  the  modifications  of  composition  that  they 
produce  in  the  blood. 

In  spontaneous  anaemia,  whether  strongly  marked  or  not, 


OP  THE  BLOOD  IN  DISEASES.  45 

the  globules  alone  are  diminished :  the  fibrine  and  the  solid 
matter  of  the  serum  have  preserved  their  normal  proportions ; 
thus  in  16  cases  of  slight  ansemia,  I  have  found  as  the  average 
of  fibrine  the  cipher  3.0 ;  and  in  24  cases  of  confirmed  anaemia 
the  cipher  3.3.* 

In  the  anaemia  which  follows  more  or  less  abundant  losses 
of  blood,  it  may  equally  happen  that  we  shall  find  the  glo- 
bules alone  diminished ;  that  is  indeed  the  first  eflect  of  every 
hemorrhage ;  but  if  this  augments  or  is  renewed,  there  soon 
arrives  a  moment  when  the  blood  comes  to  lose  equally  its 
other  principles,  and  we  see  the  albumen  and  the  fibrine  of 
the  serum  diminish  with  the  globules.  It  is  in  this  way  that 
in  a  woman  who  had  suffered  from  very  abundant  attacks  of 
metrorrhagia,  the  blood  contained  only  21  in  globules,  1.8  in 
fibrine,  and  Gl  of  solid  matter  of  the  serum.  The  water  had 
risen  to  the  enormous  proportion  of  915. 

Anaemia  may  also  be  the  result  of  certain  appreciable  modi- 
fications of  the  organism  which  exercise  an  influence  on  the 
blood.  In  this  case,  the  composition  of  that  fluid  appears  to  be 
the  same  as  in  spontaneous  anssmia,  that  is  to  say  the  globules 
alone  are  diminished,  while  the  fibrine  and  albumen  of  the 
serum  remain  the  same.  This  is  what  occurs  in  many  preg- 
nant women  whose  blood  loses  its  globules  without  losing  its 
fibrine.  The  average  of  the  globules  is  the  same  in  them  as 
we  have  found  it  in  cases  of  slight  anaemia. 

Why  is  it  that  woman  is  more  exposed  than  man  to  this 
smgular  alteration  of  the  blood  in  virtue  of  which,  without 

*  The  state  of  the  blood  of  animals  "shows  perfectly  to  what  point  the 
fibrine  and  the  globules  may  remain  isolated  in  their  increase  or  diminution; 
thus,  the  dog  whose  blood  contains  much  less  fibrine  than  that  of  man  and  of 
all  other  animals  that  I  have  examined,  is  precisely  the  animal  whose  blood 
is  most  rich  in  globules.  On  the  contrary  the  horse,  the  sheep,  the  ox,  whose 
blood  contains  more  fibrine  than  that  of  man,  and  especially  than  that  of  the 
dog,  have  in  their  blood  much  less  of  globules  than  the  two  other  beings. — 
(See  the  Memoire  sur  la  composition  du  sang  de  quelques  animaux  domestiques, 
etc.)  Besides,  in  the  same  species,  those  individuals  who  possess  in  their 
blood  the  most  globules  are  not  those  whose  proportion  of  fibrine  necessarily 
rises  highest,  and  vice  versa. 


46  PATHOLOGICAL  HEMATOLOGY. 

any  evident  cause,  the  globules  of  this  fluid .  are  thus  dimin- 
ished in  SO  strong  a  proportion  ?  Why  is  she  particularly  ex- 
posed to  it  at  a  certain  epoch  of  her  life  ? 

Yet  men  also  are  sometimes  attacked  with  spontaneous  anae- 
mia ;  they  present  in  such  a  case  all  the»symptoms  which  cha- 
racterize the  chlorosis  of  the  female,  and  I  have  proved  that 
their  blood  then  suffers  the  same  alteration  of  composition  ;  it 
is  with  them  equally  the  globules  alone  which  diminish;  the 
fibrine  and  the  solid  matter  of  the  serum  remain  the  same.  I 
have  met  with  examples  of  this  spontaneous  diminution  of  the 
globules  both  in  men  still  young,  and  in  others  aged  from  forty 
to  sixty  years. 

When  the  influence  of  lead  has  acted  for  a  long  time  upon 
the  human  constitution,  there  may  result  from  it  the  produc- 
tion of  a  cachectic  condition,  very  well  described  by  Doctor 
Tanquerel ;  I  have  found  that,  in  this  condition,  the  globules 
of  the  blood  sufler  as  great  a  diminution  as  in  spontaneous 
anaemia,  and,  as  in  this  latter,  the  fibrine  and  other  elements 
of  the  blood  preserve  their  normal  quantity.  This  effect  of  the 
saturnine  intoxication  repeated  or  prolonged  is  certainly  very 
remarkable. 

It  would  be  very  curious  to  know  whether  the  globules  at 
the  same  time  that  they  are  diminished  in  quantity  in  anaemia, 
do  not  become  altered  also  in  their  structure,  and  tend  to 
undergo  a  true  destruction.  I  announced  in  my  course  at  the 
Faculte  in  1840-41,  the  results  that  some  microscopic  research- 
es undertaken  with  this  view  have  yielded  me.  It  seemed 
to  me,  in  two  cases  of  chlorosis,  that  the  globules  were  become 
smaller  than  we  generally  see  them,  and  at  the  same  time  a 
certain  number  had  no  longer  their  accustomed  form ;  they 
appeared  in  the  field  of  the  microscope,  as  though  broken,  and 
disseminated,  like  kinds  of  fragments.  A  young  girl  who 
presented  me  this  singular  condition  of  the  globules,  on  the 
6th  of  December,  1840,  was  perfectly  cured  two  months  later ; 
her  constitution  had  even  undergone  such  a  metamorphosis, 
that  it  had  gradually  arrived  under  our  own  observation  at  a 
plethoric  condition;  the  14th  February  1841, 1  was  obliged  to 


OF  THE  BLOOD  IN  DISEASES.  47 

bleed  her,  and  her  blood  then  presented  me  very  beautiful 
globules,  extremely  different  from  those  that  I  had  observed 
in  December. 

These  facts  seem  to  me  of  so  much  interest  and  import- 
ance as  to  make  me  feel  the  necessity  of  seeing  them  again, 
before  accepting  them  definitely,  and  drawing  deductions  from 
them. 

The  physical  properties  of  the  blood  in  anaemia  are  very 
well  accounted  for  by  the  nature  of  the  changes  that  it  has 
undergone  as  to  its  composition. 

In  the  most  ordinary  condition,  the  one  in  which  the  only 
change  undergone,  consists  in  a  diminution  of  its  globules,  the 
blood  presents  to  the  naked  eye  the  following  appearance  : 

Supposing  it  to  have  flowed  freely,  we  find  in  the  vessel 
which  has  received  it  a  small  clot  which  swims  in  the  midst 
of  an  abundant  and  perfectly  colourless  serosity.  This  clot, 
far  from  being  soft,  as  we  might  have  expected,  is  on  the 
contrary  remarkable  for  its  density ;  its  molecules  retain  a 
strong  power  of  cohesion,  and  it  is  not  at  all  uncommon  to  find 
upon  its  surface  a  very  characteristic  buff ;  one  might  take  it 
for  pleuritic  blood,  or  for  that  of  an  acute  articular  rheuma- 
tism. This  density  of  the  clot,  and  the  buff  which  covers  it, 
are  the  more  marked  in  proportion  as  the  anaemia  is  more  con- 
siderable. The  existence  of  cupped  blood  in  anaemia  is  not  a 
new  fact  in  science.  Borsieri,  amongst  others,  had  noticed 
the  presence  of  the  buff  in  the  blood  of  chlorotic  patients,  and 
he  had  with  good  reason,  drawn  from  this  an  argument  against 
those  who  pretended  that  this  crust  was  always  the  necessary 
indication  of  a  phlegmasia ;  and  it  is  curious  to  find  that  Tom- 
masini,  who  had  also  seen  the  coagulum  of  the  blood  of  chlo- 
rotic patients  become  covered  with  a  buffy  c^at,  would  not 
for  that  abandon  the  principle  sustained  by  him,  that  there  is 
no  buff  in  the  blood  without  inflammation ;  for,  said  he,  chlo- 
rosis is  nothing  more  than  a  chronic  angioVtis.  Such  an  asser- 
tion does  not  even  require  refutation.* 

•  Tommasini  suU'  inflammazione,  t.  11,  p.  250  to  278. 


48  PATHOLOGICAL  HEMATOLOGY. 

I  reffard  as  incontestable,  the  fact  that  the  clot  of  the  blood 


.g«.il^     ^^     Xi^V.WiX,,V.OlC..^lV., 


• 


of  chlorotic  patients  is  often  buffed,  and  like  Borsieri,  I  have 
from  this  long  since  drawn  the  inference  that  the  presence  of 
the  buff  is  not  always  evidence  of  the  existence  of  an  inflam- 
matory disease,  for  chlorosis  is  certainly  not  of  this  character. 
But  why  is  the  blood,  in  this  disease,  often  cupped  ?  It  is 
because  the  blood  of  chlorotic  patients  has  retained  all  its 
fibrine,  and  lost  some  of  its  globules ;  it  is  in  consequence 
of  this  that  there  is  really  in  this  blood,  as  in  that  of  inflamma- 
tions, or  as  exists  normally  in  the  blood  of  some  animals, 
excess  of  fibrine  in  proportion  to  the  globules;  now,  whenever 
this  excess  takes  place,  whether  it  be  absolute  or  relative,  and 
whenever  at  the  same  time  the  coagulation  of  the  fibrine  is 
not  very  much  too  rapid,  this  principle  will  be  seen  to  accu- 
mulate alone  on  the  surface  of  the  clot,  and  the  cup  will  appear. 
This  is  the  reason  why  the  blood  of  anaemic  individuals  may 
be  buffed,  and  why  that  of  plethoric  individuals  is  not ;  it  is 
the  cause  also  why  the  coagulum  of  blood  is  firmer  and  more 
dense  in  the  first  than  in  the  last.  It  is  also  one  of  the  circum- 
stances which  explains  the  constant  existence  of  the  buff  in 
the  blood  of  the  horse.  We  must  add  to  this,  in  the  latter 
animal,  the  greater  slowness  of  the  coagulation  of  the  fibrine. 

Thus,  all  those  various  functional  disorders  which  accom- 
pany anaemia  correspond  to  an  alteration  of  the  blood  which 
is  always  the  same,  to  wit,  a  diminution  of  the  globules,  and 
the  intensity  of  these  disorders  is  so  much  the  greater  in  pro- 
portion as  the  globules  have  themselves  undergone  a  more 
considerable  diminution  of  their  cipher.  If  this  diminution  be 
slight,  it  is  compatible  with  the  persistence  of  a  certain  phy- 
siological condition  ;  if  it  becomes  rather  greater,  the  disease 
commences.  Whatever  indeed  be  the  cause  that  may  have 
brought  on  diminution  of  the  globules,  the  resulting  symptoms 
differ  only  in  relation  to  their  degree  of  development ;  but  re- 
main the  same  as  to  their  nature.  Whenever  we  find  the 
diminution  of  the  globules  to  coincide  with  that  of  the  albu- 
men, or  with  that  of  the  albumen  of  the  serum,  we  shall  ob- 
serve peculiar  symptoms  appear,  which  I  purpose  mentioning 


OF  THE  BLOOD  IN  DISEASES.  49 

further  on ;  so  that  what  I  am  about  to  say  at  present  will 
regard  only  the  most  common  case  of  all,  that  in  which  the 
anaemia  is  tlie  simple  manifestation  of  a  diminution  of  the 
globules  alone. 

Tlie  blood  cannot  be  deprived  of  a  certain  quantity  of  its 
globules,  without  there  resulting  from  it  great  prostration  of 
the  muscular  system,  very  marked  general  feebleness,  grave 
perturbations  of  the  nervous  system,  which  are  betrayed  by 
different  disorders  of  the  intelligence,  of  sensation  and  of  mo- 
tion ;  and  various  disorders  of  the  functions  of  digestion,  res- 
piration and  circulation.  Who  is  ignorant  of  the  various 
neuroses  to  which  anaemic  patients  are  subject,  their  dyspepsia, 
their  dyspncea,  their  palpitations  of  the  heart  ?  Who  has  not 
observed  the  singular  discoloration  of  their  skin  and  exterior 
mucous  membranes,  which  is  so  naturally  explained  by  the 
small  number  of  colouring  globules  which  still  flow  in  their 
vessels  ?  But  what  is  less  generally  known  is,  that  it  is  not 
uncommon  to  meet  with  individuals  whose  colour  remains 
natural,  whose  cheeks  even  are  habitually  injected  to  a  re- 
markable extent,  and  whose  external  aspect  would  easily 
make  us  regard  them  as  of  a  plethoric  habit,  but  who  neverthe- 
less have  in  their  blood,  an  insufficient  quantity  of  globules ; 
this  is  because  there  exists  in  them  a  false  appearance  of  ple- 
thora. Observe  in  effect  such  individuals  a  little  more  closely, 
and  you  will  be  struck  with  their  feebleness ;  they  will  have, 
as  in  the  most  advanced  anaemia,  vertigo,  dyspnoea,  and  pal- 
pitations, upon  the  slightest  effort ;  they  will  bear  with  diffi- 
culty any  kind  of  exertion,  and  still  worse  venesection,  which 
far  from  diminishing,  will  increase  their  symptoms.  All  this 
shows  that  the  diminution  of  the  globules  of  the  blood,  before 
betraying  itself  by  the  discoloration  of  the  cutaneous  tissue, 
may  declare  its  existence  by  the  perturbation  wliich  it  pro- 
duces in  the  different  vital  acts,  and  this  perturbation  is  always 
marked  by  symptoms  perfectly  identical. 

There  is  a  phenomenon  revealed  to  us   by  auscultation, 
which  constantly  coincides  with  a  certain  diminution  ol  the 
globules ;  this  is  the  singular  bellows-sound,  heard  in  the  iicart, 
5 


50  PATHOLOGICAL  HJEMATOLOGT. 

and  especially  in  the  arteries,  in  all  cases  of  anaemia  however 
slight.  For  its  manifestation,  it  is  necessary  that  the  impove- 
rishment of  the  blood  should  have  fallen  upon  the  globules ; 
it  is  not  present  when  the  fibrine  alone  has  been  diminished ;  so 
that  I  have  never  met  with  it  in  scorbutic  patients,  unless  they 
had  reached  that  period  at  which  the  globules,  at  first  unaf- 
fected, yield  in  their  turn.  Neither  have  I  met  with  this  bruit 
de  souffle,  in  the  cases  which  will  be  detailed  farther  on,  where 
the  impoverishment  of  the  blood  is  owing  particularly  to  a 
diminution  of  the  albumen  of  the  serum.  Remark  in  addition, 
what  the  analysis  of  88  cases  in  which  this  bruit  existed  in  the 
carotid  arteries, either  continuously  or  intermittently,  has  taught 
me,  in  regard  to  the  relation  to  establish  between  the  diminu- 
tion of  the  globules  of  the  blood,  and  the  appearance  of  the 
bellows-sound  in  the  arteries. 

Of  these  88  cases,  there  were  56  in  which  the  souffle  was 
continuous,  and  32  in  which  it  was  intermittent. 

Of  the  5Q  cases  in  which  the  bruit  de  souffle  was  continuous, 
and  represented  what  M.  Bouillaud  has  called  the  bruit  de 
diable,  I  found  28  in  which  the  cipher  of  the  globules  had  not 
risen  above  80,  and  had  fallen  even  to  21;  I  found  13  in 
which  the  cipher  varied  between  80  and  100 ;  10  where  it  had 
risen  from  100  to  115 ;  and  5  again  where  from  1 15  it  had  in- 
creased even  up  to  125. 

Of  the  32  cases  in  which  the  bruit  de  souffle  was  merely 
intermittent,  there  were  only  3  below  80  in  globules  (76,  77, 
77);  13,  from  80  to  100  ;  8,  from  100  to  115 ;  8  others  from 
115  to  126. 

We  see  then  that  the  bruit  de  souffle  of  the  arteries  does 
not  always  show  itself  with  the  same  degree  of  diminution  of 
the  cipher  of  the  globules,  in  different  individuals ;  there  are 
nevertheless  some  rules  to  be  established  in  regard  to  this,  such 
as  the  following : 

1.  When  the  globules  are  so  much  diminished  as  to  be 
below  the  cipher  .80,  the  bruit  de  souffle  exists  in  the  arteries 
as  a  constant  condition.  I  have  not  found  a  single  exception 
to  this  law. 


OF  THE  BLOOD  IN  DISEASES.  51 

2.  Wlien  the  globules  remain  above  this  cipher  80,  the  bruit 
de  souffle  may  still  show  itself,  but  it  is  no  longer  constant  : 
we  continue  to  hear  it  not  unfrequently,  while  the  cipher  of 
the  globules  oscillates  between  80  and  100 ;  it  is  still  heard, 
but  much  less  frequently,  in  proportion  as  the  cipher  of  the 
globules  passes  100,  and  finally  is  no  longer  observed,  at 
least  as  dependent  upon  an  alteration  of  the  blood,  when  the 
cipher  of  the  globules  has  risen  above  its  physiological  mean. 

Whatever  be  in  other  respects  the  nature  of  the  disease 
in  which  the  diminution  of  the  globules  exist,  the  bruit  de 
souffle  of  the  carotids  does  not  the  less  show  itself;  I  have 
verified  it  in  the  most  opposite  cases,  in  putrid  fevers,  in  erup- 
tive fevers,  pneumonia,  acute  articular  rheumatism,  and  in  a 
great  number  of  chronic  diseases.  But  in  all  these  cases  it 
occurred  only  in  connection  with  the  ciphers  of  the  globules 
above  indicated. 

The  bruit  de  souffle  shows  itself  sufficiently  often  in  preg- 
nant women,  which  is  in  relation  with  the  frequent  diminution 
that  the  globules  undergo  in  them. 

The  intensity  of  the  bellows-sound,  is  commonly  subordinate 
to  the  degree  of  diminution  of  the  cipher  of  the  globules. 

Thus  in  22  cases  of  chlorosis,  I  have  found  the  intermittent 
souffle  8  times,  the  cipher  of  the  globules  oscillating  between 
117  and  77,  and  the  continuous  souffle  14  times,  the  cipher  of 
the  globules  varying  from  1 1 3  to  28. 

1  have  sought  to  find  as  to  what  extent  the  diminution  of 
the  globules  exercised  an  influence  upon  the  temperature  of  the 
living  body,  but  have  arrived  in  this  respect  at  results  merely 
negative.  1  have  been  not  a  little  surprised  to  observe  this 
temperature  remain  normal,  even  in  cases  where  the  globules 
had  undergone  the  most  considerable  diminution  of  their 
cipher.  It  is  thus  that  individuals  who  had  in  their  blood  no 
more  than  50,  40,  30  and  even  21  parts  in  globules  for  1,000 
parts  of  blood,  preserved  nevertheless  in  the  axilla  a  tempera- 
ture which  varied  between  37  and  38°  centigrade  :  is  not  this 
the  temperature  which  belongs  to  the  greater  part  of  men  in 
health  ?     And  not  only  does  the  temperature  not  fall  because 


52  PATHOLOGICAL  HiEMATOLOGY. 

the  globules  diminish,  but  we  see  it  even  rise,  notwithstanding 
this  diminution,  as  always  happens,  when  anssmic  persons  are 
attacked  with  fever  j  for  they  are  exposed  to  this  like  other 
individuals. 

We  must  not  then  forget  that  at  the  commencement  of  every 
disease,  the  blood  may  present  two  great  modifications  in  its 
globules,  one  of  which  belongs  to  plethora,  and  the  other  to 
anaemia.  It  is  upon  a  variation  of  increase  or  diminution  in 
the  cipher  of  the  globules  that  depend  the  peculiar  symptoms 
then  observed,  and  which  are  superadded  to  those  of  the 
disease. 


ARTICLE  III. 
Of  the  Blood  in  the  Pyrexix. 

The  pyrexiae  form  a  large  class  of  acute  diseases  which  it 
has  vainly  been  sought  to  dismiss  from  nosological  systems, 
in  order  to  throw  them  all  into  the  order  of  simple  inflamma- 
tions. Such  pretensions  however  cannot  be  maintained :  the 
pyrexiae  exist  as  diseases  apart ;  the  causes  which  often  de- 
velope  them,  the  symptoms  which  characterize  them,  the  spe- 
cial nature  of  the  alterations  that  they-  produce  in  the  solids, 
the  epoch  of  development  of  these  alterations  often  posterior 
to  that  of  the  febrile  movement,  here  are  already  enough  of 
grave  reasons  for  not  confounding  the  pyrexias  and  the  phleg- 
masiae  ;  but  the  analysis  of  the  blood  comes  still  more  to  estab- 
lish a  very  remarkable  difference  between  the  one  and  the  other 
class ;  the  results  furnished  by  this  analysis  have  something  so 
marked,  that  they  seem  to  me  to  fix  in  a  definite  manner  the 
distinction,  vainly  combated,  between  the  pyrexiae  and  the 
phlegmasiae  ;  this  is  what  I  am  about  to  endeavour  to  prove. 

Whilst,  in  the  phlegmasiae,  there  are  always  two  constant 
alterations  which  march  together,  that  of  a  solid,  and  that  of 
the  blood,  it  is  no  longer  the  same  in  the  pyrexiae  ;  in  these 
diseases  in  reality,  the  only  phenomenon  which  never  fails,  is 


OP  THE  BLOOD  IN  DISEASES.  53 

the  fever  itself;  the  various  alterations  of  which  the  solids  are 
the  seat,  may  be  entirely  wanting,  nor  do  the  changes  of  com- 
position that  analysis  has  discovered  in  the  blood  appear  in  all 
cases ;  so  that,  in  the  present  condition  of  our  knowledge,  the 
character  of  the  pyrexiae  still  remains  a  negative  one  ;  that  is 
to  say,  that,  luitil  more  fully  inquired  into,  the  fever,  which 
accompanies  the  pyrexiae,  recognizes  neither  in  the  solids,  nor 
in  the  blood,  any  constant  alteration  that  can  account  for  it. 
Nevertheless,  we  can  more  or  less  frequently,  find  alterations 
in  the  blood  and  in  the  solids  ;  yet  these  are  but  the  effects  of 
a  more  hidden  cause  which  governs  the  constitution,  effects 
however  which  it  is  important  to  study  thoroughly,  since  in 
their  turn  they  themselves  become  causes  of  a  certain  number 
of  symptoms,  and  because  by  their  seat  and  by  their  nature, 
they  serve  to  classify  and  denominate  the  pyrexiae. 

In  my  first  memoir  upon  the  alterations  of  the  blood,  I  have 
proved  that,  the  fibrine  never  augments  in  the  pyrexiae,  sup- 
posing them  divested  of  all  phlegmasial  complication ;  that  it 
often  remains  in  normal  quantity,  and  that  sometimes,  it  di- 
minishes to  a  point  at  which  we  do  not  find  it  in  any  other 
acute  disease.  I  have  shown  that  the  pustules  of  variola,  and 
the  dothinenteric  plaques  of  typhoid  fever,  do  not  have  the 
power  of  increasing  the  cipher  of  the  fibrijie ;  and  finally  I 
have  shown  that  with  all  the  possible  proportions  of  the  glo- 
bules, whether  they  were  very  abundant,  or  whether  they 
have  become  very  rare,  a  pyrexia  could  equally  arise  with  all 
its  varieties  of  form  and  gravity. 

But  is  it  indifferently,  and  as  it  were  by  chance,  that  the 
fibrine  shows  itself,  in  the  pyrexiae,  either  in  normal  quantity, 
or  in  a  proportion  infinitely  more  feeble  than  in  the  physiolo- 
gical condition  ?  No,  without  doubt,  and  with  regard  to  this, 
very  clear  general  principles  may  be  laid  down. 

At  every  period  of  clmical  observation,  and  upon  whatever 
theoretical  point  of  view,  the  observer  was  placed,  it  has  been  re- 
cognized that  amongst  the  pyrexiae,  there  were  some  miattended 
by  any  grave  symptoms,  which  marched  naturally  towards  a 
favourable  termination ;  while  there  were  others  which,  either 

5* 


54  PATHOLOGICAL  HJEMATOLOGT. 

at  their  commencement,  or  during  their  course,  were  accom- 
panied by  accidents  of  such  a  nature,  that  it  seemed  as  though 
the  forces  which  rule  the  organism  were  either  vanquished,  or 
profoundly  disordered  to  such  an  extent  that  the  extinction  of 
life  must  be  the  consequence ;  and  at  the  same  time  it  was 
found  that  in  such  cases  the  blood  presented  an  altogether 
peculiar  appearance  ;  it  was  observed  that,  become  less  con- 
sistent, it  seemed  to  tend  towards  a  sort  of  dissolution.     Ad- 
mitted at  all  periods,  but  differently  explained  according  to  the 
prevailing  theories,  this  condition  which  may  develope  itself 
in  any  pyrexia,  and  towards  which  several  seem  to  tend  natu- 
rally, has   been  called  turn  by  turn  putrid,  adynamic   and 
typhoid  state :  it  has  its  greatest  development  in  the  typhus 
fevers  properly  so  called ;  it  is  in  some  sort  inherent  in  them ; 
it  is  as  it  were  their  essence.    The  pyrexia  now  called  typhoid 
fever,  presents  it  in  a  slight  degree  from  the  invasion  and  the 
grave  cases  of  this  disease  are  its  marked  representation.     It 
does  not  ordinarily  exist  in  the  eruptive  fevers,  but  it  often 
complicates  them,  and  constitutes  one  of  their  dangers.  Finally, 
in  addition  to  the  pyrexiae  with  well  marked  characters,  and 
which  have  a  fully  determined  place  in  nosological  systems, 
there  are  others  to  which  no  name  has  been  given,  which  may 
yet  present  in  a  high  degree  the  different  symptoms  to  which 
the  ancients  attached  the  idea  of  the  putrid  state.     This  is 
because  there  may  exist  in  effect,  in  all  the  pyrexiae,  a  com- 
mon alteration  of  which  the  blood  is  the  seat,  and  whose  exist- 
ence constantly  coincides  with  the  appearance  of  those  phe- 
nomena always  the  same,  attributed  by  vitalism  to  adynamia, 
by  solidism  to  relaxation  of  the  fibre,  and  by  humorism  to 
putridity  of  the  humours.     This  alteration  of  the  blood  consists 
of  a  diminution  of  its  fibrine ;  it  is  consequently  an  alteration 
the  inverse  of  that  which  betrays  in  the  blood  the  phlegmasial 
condition. 

This  diminution  of  fibrine,  every  time  that  it  takes  place, 
produces  remarkable  modifications  in  the  physical  qualities  of 
the  blood.  Whatever  be  the  pyrexia  in  which  it  exists,  blood 
drawn  from  a  vein  presents  the  following  condition:        tf'^^, 


OP  THE  BLOOD  IN  DISEASES.  55 

The  serum  and  the  clot  are  imperfectly  separated  from  each 
other,  whence  it  follows  that  there  seems  to  be  but  little  serum 
in  proportion  to  the  clot. 

The  clot  is  voluminous,  it  often  fills  the  whole  breadth  of 
the  vessel  in  which  the  blood  has  been  received ;  it  is  never 
elevated  upon  its  borders,  as  is  so  commonly  the  case  with  the 
clot  of  the  phlegmasia3.  Its  consistence  is  always  slight,  it  is 
torn  and  broken  with  the  greatest  facility,  and  there  are  some 
cases  even  where,  by  the  slightest  pressure,  it  may  be  reduced 
to  a  true  condition  of  diffluence  ;  it  ceases  then  to  form  a  single 
mass,  and  is  divided  into  a  number  of  grumous  portions  which 
mix  with  the  serum,  and  colour  it  of  a  more  or  less  deep  red. 
This  is  the  condition  of  dissolution  of  the  blood  so  well  de- 
scribed by  the  ancients,  and  which  ought  to  be  regarded  as 
the  necessary  consequence  of  the  diminution  that  the  sponta- 
neously coagulable  matter  of  this  tiuid  has  undergone.  Then, 
in  effect,  the  net- work,  which  maintained  the  globules  pressed 
one  against  the  other,  and  which  by  its  power  of  contraction 
squeezed  out  the  serum,  no  longer  exists  but  imperfectly ; 
thence  also  arises  the  great  size  of  the  clot,  which  is  found  to 
be  in  an  inverse  proportion  to  its  density,  and  which  is  not  a 
certain  index  of  the  quantity  of  solid  material  that  it  contains. 
Let  us  add  however  that  the  cause  of  the  large  size  of  the  clot, 
is  really  also  the  large  proportion  of  globules  that  it  contains, 
especially  in  the  early  stages  of  the  disease  ;  for  these  do  not 
diminish  in  such  cases,  like  the  fibrine ;  far  from  that,  they 
may  become  remarkable  by  their  abundance.  Very  fre- 
quently, hideed,  I  have  been  struck  by  the  great  elevation  of 
the  cipher  of  the  globules  in  individuals  with  grave  typhoid 
fever;  and  in  my  first  memoir  upon  the  alterations  of  the 
blood,  I  was  even  inclined  to  suppose  that  this  superabundant 
quantity  of  globules  was  one  of  the  characters  of  that  fluid  in 
the  pyrexia3 ;  but  this  was  because  1  had  not  then  sufllciently 
studied  the  condition  of  the  blood  in  the  plethoric ;  since  then 
I  have  convinced  myself,  that  if,  in  typhoid  fever,  we  often 
find  this  predominance  of  the  globular  element  of  the  blood,  it 
depends  on  the  fact  that  typhoid  fever  most  frequently  attaclis 


56  PATHOLOGICAL  HEMATOLOGY. 

individuals,  who  by  their  age  and  constitution,  are  in  a  con- 
dition of  plethora  more  or  less  marked  ;  but  the  superabund- 
ance of  the  globules  depends  so  little  upon  the  typhoid  fever 
itself,  that  this  disease,  as  I  have  myself  seen,  may  occur  m 
chlorotic  girls,  whose  blood  is  so  poor  in  globules.  But 
whether  these  be  abundant  or  not,  the  influence  of  the  disease 
upon  the  fibrine  remains  always  the  same. 

There  is  another  quite  negative  character  of  the  blood  in 
^  ,  /,  , ,      the  pyrexias,  which  is  of  importance  and  which  serves  still 
„ff/i  -        more  to  distinguish  the  sanguine  fluid  of  these  diseases  from 
that  of  the  phlegmasiae.     This  character  is  the  absence  of  the 
,  ,  bufl".     I  may  aflh'm  here  that  I  have  never  met  with  it,  unless 

there  was  some  phlegmasial  complication,  either  in  inflamma- 
tory fever,  in  slight  or  severe  typhoid  fever,  in  measles,  in  scar- 
latina, or  in  variola. 

Nevertheless,  we  may  find  the  bufl"  upon  the  surface  of  the 
clot,  in  this  latter  pyrexia,  when  the  eruption  is  very  confluent, 
and  especiaUy  when  collections  of  pus  exist  beneath  the  skin, 
or  in  some  organ;  but  this  bufli"  always  appeared  to  me  to 
have  a  pecifliar  aspect ;  far  from  being  firm  and  consistent, 
like  the  ordinary  crust  of  the  phlegmasiae,  it  is  very  soft,  and 
gelatinous  as  it  were,  and  however  thick  it  may  at  first  appear, 
may  be  rapidly  changed  into  quite  a  thin  pellicle,  by  expel- 
ling by  means  of  compression,  the  large  quantity  of  serosity 
which  infiltrates  it. 

If,  as  I  have  already  proved,  the  indispensable  condition  for 
the  formation  of  the  inflammatory  crust,  is  a  certain  excess  of 
fibrine  in  proportion  to  the  globules,  we  can  understand  why 
this  should  not  exist  in  the  pyrexias,  since,  in  these  diseases, 
supposing  them  always  without  phlegmasial  complication, 
two  cases  only  can  occur,  one  in  which  the  fibrine  has  retained 
its  normal  proportion,  and  the  other  in  which  it  has  dimin- 
ished. 

Since  the  diminution  of  the  fibrine  does  not  exist  necessarily 
in  any  pyrexia,  it  is  perfectly  clear  that  it  is  not  in  this  altera- 
tion of  the  blood,  that  we  should  place  the  point  of  departure 
of  this  class  of  diseases.     But  what  seems  to  me  incontestable, 


OF  THE  BLOOD  IN  DISEASES.  57 

is,  that  the  specific  cause  which  gives  them  birth,  acts  upon 
the  blood  in  such  a  way,  that  it  tends  to  destroy  its  spontane 
ously  coagulable  matter,  while  the  cause  which  produces  the 
phlegmasias,  tends  on  the  contrary  to  create  in  that  fluid  a 
fresh  proportion  of  that  matter.  If  this  cause  act  with  slight 
energy,  or  if  the  economy  resist  it,  the  destruction  of  the  fibrine 
is  not  accomplished;  if  on  the  contrary  the  cause  continue  to 
act  with  all  its  intensity,  and  the  forces  of  the  organism  be  in 
fault,  the  destruction  of  the  fibrine  will  commence  either  at 
the  very  beginning  of  the  disease,  which  is  very  rare,  or  a  cer- 
tain period  after  its  commencement :  all  this  applies  itself 
equally  well  both  to  typhoid  fever,  and  to  the  eruptive  fevers. 
For  me  there  is,  in  all  these  cases,  a  true  intoxication ;  if  it  be 
slight,  its  effect  must  to  be  sure  always  exist,  but  it  is  not  ap- 
preciable ;  if  the  intoxication  be  stronger,  the  effect  which  it 
has  produced  upon  the  blood  becomes  visible,  and  is  marked 
in  that  fluid,  by  a  diminution  of  the  fibrine. 

Whilst  then  we  establish,  in  certain  forms  of  typhoid  fever 
or  scarlatina,  that  alteration  of  the  blood  which  consists  in  a 
tendency  to  the  destruction  of  its  spontaneously  coagulable 
matter,  we  no  more  attain  by  this  means  the  true  cause  of  the 
disease,  than  we  do,  by  studying  the  alterations  of  which  the 
tegumentary  membranes  are  the  seat.  But,  as  these  altera- 
tions of  the  mucous  membrane  or  of  the  skin,  once  produced, 
bear  their  part  in  the  production  of  the  symptoms,  just  so  does 
the  peculiar  alteration  of  the  blood,  which  may  then  arise, 
bear  its  part. 

Amongst  the  phenomena  which  seem  to  me  to  have  a  direct 
connection  with  the  diminution  of  the  fibrine,  I  believe  I  ought 
to  place  in  the  first  rank  the  hemorrhages  that  are  so  common 
in  all  the  pyrexiai  in  which  the  adynamic  or  putrid  type  pre- 
dominates, that  is  to  say  those  in  which  it  has  been  proved  by 
analysis  that  the  blood  had  lost  some  of  its  fibrine.  In  variola, 
when  the  pustules  are  filled  with  blood,  in  scarlatina,  when 
there  are  abunda«iit  losses  of  blood  from  all  parts,  in  individuals 
attacked  with  acute  purpura  hemorrhagica,  as  well  as  in  ty- 
phoid fevers  accompanied  with  epistaxis  and  buccal  hemor- 


58  PATHOLOGICAL  IliEMATOLOGY. 

rhages  which  increase  with  the  debiUty,  I  have  shown  that 
the  blood  was  effectively  very  poor  in  fibrine,  and  1  shall  essay 
to  prove  further  on  that  we  cannot  in  such  cases  accuse  the 
hemorrhage  of  having  diminished  the  fibrine.  It  would  seem 
that  in  this  condition  a  certain  diminution  of  the  spontaneously 
coagulable  matter  of  the  blood  has  for  effect  to  permit  the  glo- 
bules to  abandon  more  readily  the  vessels  which  contain 
them. 

How  again  fail  to  remark  the  coincidence,  so  frequent  in 
the  pyrexias,  of  the  diminution  of  the  fibrine  of  the  blood,  and 
of  the  facility  of  production  of  those  congestions  or  sanguine 
states  which  have  so  often  been  confounded  with  true  inflam- 
mations ?  wherefore  this  coincidence  ?  Deprived  of  the  ordi- 
nary quantity  of  fibrine  borne  along  with  them  in  the  torrent 
of  the  circulation,  are  the  globules  at  the  same  time  deprived 
of  a  means  of  regularization  for  their  movements,  and  do  they 
come  in  this  way  to  accumulate  and  stagnate  in  the  capillary 
rete  ?  I  know  not ;  but  it  must  be  that  there  is  some  con- 
nection of  cause  and  effect  between  the  diminution  of  the 
fibrine  of  the  blood  and  the  production  of  these  congestions, 
since  these  latter  follow  so  constantly  the  former.* 

There  is  a  peculiar  congestion  which  rarely  presents  itself 
except  when  there  exists  a  typhoid  condition,  whatever  be  in 
other  respects  the  disease  in  the  course  of  which  this  condition 
n  ^  may  have  arisen.     This  congestion  has  its  seat  in  the  spleen, 

which  becomes  remarkable  at  the  same  time  by  its  great  size, 
and  by  the  extreme  diminution  of  consistence  of  the  material 
which  fills  its  cellules.  The  softening  of  the  spleen,  noted  in 
these  cases  by  all  observers,  does  not  depend  on  an  alteration 
of  its  own  tissue :  for  it  is  found  quite  untouched,  when,  by 
washing,  it  iias  been  emptied  of  all  the  material  that  it  con- 
tains; it  is  evidently  this  latter  which  has  lost  its  usual  con- 

•  I  am  happy  to  ^ay  that  all  the  facts,  that  I  have  just  reviewed  in  this  arti- 
•    cle,  are  in  perfect  harmony  with  the  principles  emitted,  since   1837,  by  M. 
Magendie  on  this  subject.     While  employing  different  experimental  methods, 
we  have  each  arrived  at  similar  results. 


OP  THE  BLOOD  IN  DISEASES.  59 

sistence.  But,  what  is  this  material  ?  it  is  nothing  more  than 
blood  retained  and  coagulated,  I  know  not  by  what  influence, 
in  the  innumerable  cellules  or  areolae  of  which  the  splenic  tis- 
sue is  composed ;  but  this  blood  ought  to  possess  the  same 
qualities  as  any  other  blood  poor  in  fibrine,  that  is  to  say  it 
ought  to  coagulate  imperfectly;  whence  will  result,  in  the 
spleen  as  elsewhere,  a  marked  softness  and  at  the  same  time  a 
large  amount  of  clot.  It  is  always  the  same  cause  which  pro- 
duces a  similar  kind  of  modification,  whether  in  the  blood  that 
we  extract  from  the  veins  during  life,  in  that  we  collect  from 
the  heart  and  vessels  after  death,  and  in  that  again  contained 
in  the  splenic  cellules.  Thus  then,  the  augmentation  in  size 
of  the  spleen  and  'its  softening,  which  certainly  accompany 
every  well  marked  typhoid  condition,  may  be  regarded  as  the 
efl^ect  of  a  diminution  of  the  fibrine  of  the  blood,  and  this 
change  is  one  of  its  manifestations.  Let  no  one  say  moreover 
that  it  is  in  consequence  of  the  greater  rapidity  imparted  to  the 
circulation  that  the  spleen  conies  to  present  the  changes  that  I 
have  just  described  :  for,  in  the  acute  phlegmasise  with  fever, 
it  presents  nothing  of  the  kind. 

I  have  already  said  that,  however  poor  the  blood  might 
have  become  in  globules,  this  did  not  prevent  the  temperature 
proper  to  the  human  body  from  persisting  in  its  normal  con- 
dition, and  even  elevating  itself  if  there  were  occasion.  The 
same  is  true  in  cases  where  the  blood  has  lost  a  great  portion 
of  its  fibrme  :  not  only  does  not  the  temperature  of  the  body 
fall  in  consequence,  but  it  may  even  augment  several  degrees, 
just  as  in  any  other  circumstance.  Thus  I  have  found  it  at 
40°  c.  in  cases  of  typhoid  fever  when  the  blood  did  not  offer 
more  than  j-^-^-^  in  fibrine.  Yet  this  is  likewise  the  most  ordi- 
nary temperature  that  wc  find  in  individuals  who  have  fever 
symptomatic  of  an  acute  phlegmasia,  even  when  the  fibrine  has 
doubled  or  tripled  in  quantity.  Consequently  the  greater  or 
less  elevation  of  the  temperature  of  the  body  in  diseases,  is  not 
dependent  upon  the  quantity  of  fibrine  that  the  blood  may 
contain.  This  temperature  attains  its  maximum  (42°  c.)  in 
intermittent  levers  in  which,  as  I  have  assured  myself,  the 


60  PATHOLOGICAL  HEMATOLOGY. 

fibrineof  the  blood  remains  in  normal  quantity;*  and  the  ave- 
rage even  shows  itself  somewhat  more  elevated  in  typhoid 
fever  or  in  scarlatina  than  in  the  acute  phlegmasia;. 


ARTICLE  IV. 

Of  the  Blood  in  the  Phlegmasia. 

I  HAVE  now  shown  that  there  is  a  large  class  of  febrile 
diseases  in  which  the  fibrine  is  never  increased,  but  is  often 
normal,  and  often  diminished.     There  are  others,  again,  in 
which  there  is  constantly  an  increase  of  this  principle,  diseases 
which  are  symptomatic  of  that  sort  of  alteration  of  the  solids, 
which  from  time  immemorial  has  been  called  inflammation. 
This  is  not  the  place  to  criticise  the  vagueness  and  insuffi- 
ciency of  such  an  expression ;  but  it  is  my  duty  here  to  set 
forth  prominently  that  remarkable  coincidence,  in  certain  dis- 
eases, between  the  increased  quantity  of  the  spontaneously 
coagulable  matter  of  the  blood,  and  the  development  of  various 
lesions  of  the  solids,  which  although  differing  in  many  respects, 
yet  resemble  one  another  so  strongly  in  others,  that  in  all  ages 
they  have  been  classed  together  by  nosologists,  as  forming  a 
single  group  of  diseases.     And  yet  it  must  be  admitted  that 
the  organic  changes  are  much  more  uniform  in  the  blood,  than 
in  the  sohds ;  amidst  the  diverse  lesions  of  the  latter,  the  blood 
exhibits,  by  the  identity  of  the  alterations  which  it  undergoes, 
a  disease  uniformly  of  the   same  nature.     Not  long  since, 
Meckel  defined  inflammation  to  be,  co?igest/on  loith  a  ten- 
dency to  new  production.     The  study  of  the  blood  shows  the 
justness  of  this  definition.     For  what  else  than  a  new  pro- 
duction is  this  excess  of  fibrine  which  suddenly  appears  in  the 
blood  of  a  person  attacked  with  pneumonia  or  erysipelas,  with 
an  inflammation  of  the  tonsils,  of  the  tongue,  of  the  bronchia, 
or  of  the  peritoneum  ?     A  new  and  redundant  production  of 

*  See  in  our  first  memoir,  the  results  which  a  certain  number  of  analyses 
of  the  blood  in  intermittent  fevers,  have  given  to  M.  Gavarret  and  myself. 


OF  THE  BLOOD  IN  DISEASES.  61 

fibrine  in  the  blood  is,  then,  the  least  variable  sign  of  a  certain 
number  of  diseases  which  present  further  analogies  in  the  na- 
ture of  the  general  symptoms  accompanying  them,  and  in  the 
uniformity  of  the  treatment  they  require.  In  my  preceding 
essays,  moreover,  1  have  shown,  that  in  these  diseases,  the  other 
organic  constituents  of  the  blood,  and  particularly  the  globules, 
do  not  increase  with  the  fibrine. 

In  the  phlegmasige,  then,  there  is  an  excess  of  fibrine  rela- 
tively to  the  globules,  that  is  to  say  the  reverse  of  what  takes 
place  in  typhus.  Hence  may  be  explained  the  physical  pro- 
perties of  the  blood  drawn  from  a  vein,  in  these  diseases. 
While  in  the  pyrexias,  generally,  the  clot  is  bulky,  flabby,  and 
imperfectly  separated  from  the  serum,  here,  on  the  contrary  it 
is  smaller,  more  dense,  and  of  superior  consistence ;  besides 
which,  if  the  blood  has  been  properly  drawn,  the  clot  will  be 
covered  with  a  bufty  coat  of  variable  thickness. 

I  have  already  explained  myself  in  regard  to  the  value  of 
the  indications  to  be  derived  from  the  bufly  coat.     Except  -% 

when  it  occurs  in  cases  of  anaemia,  this  production  uniformly 
denotes  a  state  of  mflammation;  I  can  cite  in  support  of  this 
assertion  a  summary  of  nearly  eighteen  hundred  bleedings,  hi 
which  the  blood,  examined  by  myself,  never  presented  a  buffy 
coat  except  in  one  or  the  other  of  two  series  of  cases,  those  of 
anaemic  patients  on  the  one  hand,  and  those  of  persons  attacked 
with  various  acute  or  subacute  phlegmasicc,  on  the  other.  In 
the  former,  the  buffy  coat,  which,  indeed,  is  of  moderate  thick- 
ness, results  from  the  great  diminution  of  the  globules,  for  the 
fibrine  although  in  its  usual  quantity,  is  nevertheless  in  excess, 
relatively  to  the  globules.  But  in  the  phlegmasiae  the  globules 
are  neither  increased  nor  diminished,  while  the  fibrine  having 
become  redundant,  the  law  which  governs  the  formation  of 
the  buffy  coat  reaches  its  full  development.  jVIoreover,  the 
fibrine  of  the  new  product  entering  into  the  composition  of 
the  buffy  coat  coagulates  more  slowly  than  the  old,  which  is 
another  cause  favourable  to  the  appearance  of  the  buffy  coat, 
since  the  gradual  coagulation  of  the  fibrine  allows  the  globules 
to  sink  to  tlie  bottom  of  the  vessel,  leaving  the  fibrine  above 
6 


■»< 


qg  PATHOLOGICAL  HEMATOLOGY. 

them,  still  dissolved,  or  suspended,  in  the  serum.  Besides,  if 
an  analysis  be  made  for  the  purpose  of  determining  the  quantity 
of  librine  in  the  buffy  coat,  or  underneath  it,  some  indeed  will 
be  found  in  the  latter  situation,  but  very  little  compared  with 
what  can  be  extracted  from  the  buffy  coat  itself* 

There  is  a  striking  contrast  between  the  usually  great  firm- 
ness of  the  buffy  coat,  and  the  extreme  softness  of  that  portion 
of  the  clot  which  retains  its  colour ;  this  softness  is  always 
great  in  proportion  to  the  density  of  the  buffy  coat,  and  the 
brownish  red  mass  which  the  latter  surmounts,  bears  the  great- 
est resemblance  to  imperfect  and  half  liquid  currant-jelly.  On 
examining  this  mass  through  a  microscope,  an  accumulation 
of  globules  is  found  in  it,  while  none,  or  very  few,  can  be 

•  With  reference  to  this  subject  I  have  studied  the  clot  in  three  cases  of 
pneumonia,  and  in  two  of  acute  articular  rheumatism.  In  these  five  cases 
the  fibrine  of  the  clot  was  apportioned  in  the  following  manner: 

First  case  of  pneumonia. 

Fibrine  of  buffy  coat        -----       8.1 
Fibrine  of  rest  of  clot 1.1 

Total  fibrine  9.2 
Second  case  of  pneumonia. 

Fibrine  of  buify  coat 5.8 

Fibrine  of  rest  of  clot 3.2 

Total  fibrine  9.0 
Third  case  of  pneumonia. 

Fibrine  of  buffy  coat         -----  4.8 

Fibrine  of  rest  of  clot  -        -        -        -        -  -  2.5 

Total  fibrine  7.3 
First  case  of  articular  rheumatism. 

Fibrine  of  buffy  coat        -----  7.0 

Fibrine  of  rest  of  clot  -        -        -        -        -  -1.6 

Total  fibrine        8.6 
Second  case  of  articular  rheumatism. 

Fibrine  of  buffy  coat 7.5 

Fibrine  of  rest  of  clot 1-7 

Total  fibrine        9.2 


OF  THE  BLOOD  IN  DISEASES.  63 

detected  in  that  portion  of  the  clot  which  forms  the  buffy 
coat. 

On  examining  the  latter  in  the  earliest  periods  of  its  separa- 
tion, and  before  the  coagulation  is  visible  to  the  naked  eye,  or 
just  as  it  is  commencing,  certain  phenomena  may  be  witnessed; 
such  I  have  verified  with  M.  Gavarret,  and  which  I  will  now 
describe.. 

We  received  in  a  glass  vessel  80  grammes  (about  21  ounces) 
of  the  blood  of  a  person  suffering  from  acute  pneumonia  ;  the 
coagulation  took  place  as  usual,  and  a  buflfy  coat  soon  made 
its  appearance  upon  the  surface  of  the  clot.  Hardly  had  the 
yellowish  and  opaline  liquid  which  constitutes  its  first  rudi- 
ments appeared  above  the  mass  of  globules,  when  we  placed 
a  drop  of  it  under  the  microscope ;  then,  in  addition  to  some 
red  globules,  the  field  of  the  instrument  appeared  to  us  filled 
with  those  grain-Uke  corpuscles  whose  nature  I  have  already 
endeavoured  to  determine.  The  opaline  liquid  became  every 
moment  more  consistent ;  when  it  assumed  the  appearance  of 
a  tremulous  jelly  denoting  its  approaching  solidification,  we 
again  examined  it  under  the  microscope,  and  saw  forming 
before  our  eyes  numerous  very  fine  fibres,  resembling  long 
and  very  delicate  threads,  crossing  one  another  in  various  di- 
rections, so  as  to  leave  intervals  between  them  of  variable 
extent,  and  giving  to  the  whole  the  appearance  of  a  net-work. 
These  fibres,  at  first,  few  in  number,  and  scarcely  visible,  be- 
came more  numerous  and  more  distinct,  until  they  occupied 
the  whole  field  of  vision;  and,  as  they  increased,  formed 
superposed  planes  at  certain  points,  where  the  net-work  was 
succeeded  by  an  appearance  like  felt.  The  fundamental  form, 
however,  continued  to  be  reticular.  As  the  solidification  of 
the  bufiy  coat  proceeded,  this  appearance  of  interwoven  fibres 
disappeared,  and  there  only  remained  visible  a  confused  and 
amorphous  mass. 

I  have  repeated  this  experiment  several  times,  and  always 
with  the  same  result.  I  have  also  examined  with  a  micro- 
scope the  sero-fibrinous  liquid  which  may  be  separated  from 
the  globules,  as  already  stated,  by  subjecting  the  blood  to  the 


64  PATHOLOGICAL  H^MATOLOGT?. 

action  of  sulphate  of  soda,  and  then,  upon  examming  the  flakes 
which  quickly  appear  in  the  Uquid,  I  have  found  these  same 
reticulated  fibres.  I  shall  avail  myself  hereafter  of  this  micro- 
scopical sign  afforded  by  the  fibrme  of  the  blood,  to  prove  the 
identity  of  this  principle  with  other  spontaneously  coagulable 
matters,  which,  in  certain  cases,  are  found  mixed  with  the 
serosity. 

Here,  then,  is  the  necessary,  the  indisputable  modification 
offered  by  the  blood  in  every  inflammation  acute  enough  to 
be  accompanied  with  fever,  the  creation  in  that  fluid  of  a  new 
quantity  of  fibrine.  Here  we  have  an  explanation  of  the  phy- 
sical properties  of  the  blood  in  the  phlegmasiee,  so  different 
from  what  they  are  in  the  pyrexiae  :  here  too  the  cause  of  the 
formation  of  the  buffy  coat,  whose  fibrinous  nature  is  thus 
demonstrated  as  well  by  microscopical  examination,  as  by 
chemical  analysis. 

This  spontaneous  production  of  an  excess  of  fibrine  in  the 
blood  is,  moreover,  independent  of  the  various  conditions  in 
which  the  system  of  the  individual  attacked  with  inflamma- 
tion may  happen  to  be.  For,  remarkably  enough,  it  does  not 
fafl  to  take  place  even  when  a  phlegmasia  occurs  during  the 
course  of  typhoid  fever,  the  influence  of  which  is  to  create,  at 
least,  a  tendency  to  lessen  the  quantity  of  fibrine  in  the  blood. 
The  real  increase  of  the  fibrine  in  such  a  case  is  not,  however, 
very  great,  for  I  have  never  found  its  maximum  to  exceed  5i, 
which  number  corresponds  to  one  of  the  lowest  degrees  of  the 
inflammatory  state,  and  in  other  cases  the  amount  of  fibrine 
was  even  less,  its  increment  was  only  relative.  Does  it  not, 
then,  seem  as  if  the  fibrine  were  controlled  by  two  forces,  one 
of  which,  represented  by  the  intercurrent  phlegmasia,  urges 
its  increase,  and  the  other  represented  by  the  typhoid  fever, 
acts  in  the  opposite  direction,  and  reduces  to  its  minimum  the 
influence  of  the  phlegmasia  ?  In  this  way  we  may  under- 
stand how  the  fibrine,  although  exceeding  its  physiological 
quantity  in  cases  of  typhoid  fever  complicated  by  intercur- 
rent inflammation,  is  yet  developed  in  a  less  degree  than  if  its 


OP  THE  BLOOD  IN  DISEASES.  6^ 

increase  were  regulated  only  by  the  laws  of  the  inflammatory 
state. 

Although  the  constitution  may  be  exhausted  by  a  chronic 
disease,  or  a  more  or  less  complete  state  of  anajmia  be  estab- 
lished, the  fibrine  will  nevertheless  be  augmented  under  the 
influence  of  whatever  inflammation  may  supervene.  Nor  is 
there  any  thing  surprising  in  this ;  for,  in  the  supposed  circum- 
stances, the  globules  diminish,  while  the  fibrine  remains  nor- 
mal, so  that  its  increase,  through  the  intervention  of  the  inflam- 
matory state,  is  less  singular  than  in  the  case  of  typhoid  fever. 
In  the  above  mentioned  conditions  of  the  economy  I  have  seen 
it  increase  much  more  than  in  typhoid  fever.  In  chlorotic 
patients,  for  instance,  who  had  been  attacked  with  acute  arti- 
cular rheumatism,  capillary  bronchitis,  pneumonia,  or  erysipe- 
las, I  have  found  the  blood  to  contain  6,  7,  and  even  8  parts  of 
fibrine.  While,  tlierefore,  clinical  observation  demonstrates 
the  frequent  coincidence  of  anaemia  and  inflammation,  chemi- 
cal analysis  discloses  to  us  in  the  composition  of  the  blood, 
circumstances  which  far  from  opposing  this  coincidence,  should 
rather  be  held  capable  of  favouring  its  development.  For 
since  in  all  cases  of  general  debility  the  globules  are  dimi- 
nished, and  the  fibrine  relatively  increased,  it  follows  that  in 
the  spontaneous  anaemia  occurring  towards  the  close  of  many 
chronic  diseases,  the  proportions  of  the  several  constituents  of 
the  blood  to  one  another  are  such  that  the  state  of  this  fluid 
approximates  more  nearly  to  the  change  of  composition  eflect- 
ed  by  inflammation,  than  under  any  other  circumstances,  so 
that  the  blood  may  be  said  to  have  then  a  sort  of  predisposi- 
tion to  the  inflammatory  state. 

I  have  not  observed  that,  apart  from  the  disease  itself,  the 
differences  of  constitution  or  temperament,  of  age  or  sex, 
modified  in  any  notable  degree  the  quantity  of  fibrine  in  the 
blood.  Whether  the  individuals  attacked  with  acute  inflam- 
mation were  strong  or  feeble,  of  a  sanguine  or  lymphatic  tem- 
perament, the  increase  of  the  fibrine  was  neither  more  nor  less 
considerable,  following  only,  amidst  these  various  conditions 
of  the  organism,  the  variable  intensity  of  the  inflammation. 

6* 


66  PATHOLOGICAL  HEMATOLOGY. 

I  was  much  struck  by  a  fact  observed  in  some  experiments 
which  I  undertook  with  M.  Gavarret  in  order  to  settle  the 
composition  of  the  blood  in  animals  deprived  of  food.  This  fact 
was  a  remarkable  increase  of  fibrine ;  but  my  surprise  was  at 
an  end  when,  upon  the  dissection  of  these  animals,  1  discovered 
in  their  stomachs  lesions  of  the  most  clearly  inflammatory 
nature,  such  as  bright  redness,  softening,  and  numerous  ulcer- 
ations of  the  mucous  membrane.  From  that  time,  I  have 
seen  in  those  experiments  only  a  confirmation  of  the  principle 
I  have  just  now  laid  down,  to  wit,  the  possibility  of  an  inflam- 
mation developing  itself  in  spite  of  the  general  debility  of  the 
system,  and  the  simultaneous  increase  of  the  fibrine  of  the 
blood  in  spite  of  the  general  impoverishment  of  that  liquid. 
The  following  are  some  details  of  those  experiments. 

We  bled  three  healthy  and  well  kept  dogs.  Their  blood 
contained  fibrine  represented  by  2.3;  2.2;  and  1.6  respect- 
ively. These  variations  are  ordinary  and  physiological  in 
canine  blood,  as  I  have  elsewhere  shown.*  After  having  thus 
determined  the  composition  of  their  blood,  these  three  animals 
were  made  to  fast,  more  or  less  rigorously,  until  they  died. 

From  the  first  both  food  and  drink  were  withheld  from  De- 
cember 21st  1841  to  January  11th  1842,  when  he  died.  Dur- 
ing this  period  he  was  twice  bled,  on  December  28th  and 
January  4th.  The  quantity  of  fibrine  in  his  blood  rose  from 
2.3  to  3.9  and  4.5. 

The  second  dog  was  not  allowed  to  eat  from  December  21st 
to  January  8th,  the  day  of  his  death ;  but  all  this  time  he  was 
permitted  to  drink  water.  He  was  bled  December  28th,  Jan- 
uary 4th  and  8th,  and  the  fibrine  of  his  blood  had  risen  from 
2.2  to  2.9  and  4.0. 

The  third  dog  was  not  starved  so  absolutely :  from  Decem- 
ber 21st  to  January  16  th  he  received  every  morning  a  small 
ration  of  soup.  He  was  first  bled  December  28th,  and  again 
January  4th,  but  there  was  no  considerable  increase  of  fibrine, 
although  it  was  far  from  diminished,  being  represented  by  1.8 

*  Mem.  cit. 


OP  THE  BLOOD  IN  DISEASES.  67 

instead  of  1.6.  Such  was  not  the  case,  however,  on  January 
12th,  four  days  before  the  animal's  death,  and  when  the  influ- 
ence of  insufiicient  food  had  been  longer  felt  by  the  organism. 
In  this  third  bleeding  the  increase  of  fibrine  was  very  marked  ; 
it  had  reached  3.3.  The  proportion  was  indeed  less  than  in 
the  other  cases ;  but  it  is  worthy  of  remark  that  this  third  dog 
had  not  been  entirely  deprived  of  food,  and  was  the  only  one 
whose  stomach  was  not  ulcerated ;  the  redness  of  his  gastric 
mucous  membrane  was  also  less  general  and  less  vivid. 

Need  I  here  recall  the  fact,  that  independently  of  the  interest 
which  belongs  to  these  experiments  in  relation  to  the  subject  in 
hand,  they  entu'ely  confirm  the  opinions  which,  ever  since  the 
time  of  Hunter,  have  prevailed  in  our  science  respecting  the 
morbid  and  excessive  excitement,  and  the  inflammatory  dis- 
organization, which  may  affect  the  stomach  when,  for  a  certain 
period,  it  has  either  received  too  little  food,  or  none  at  all  ? 

No  matter,  then,  what  may  be  the  state  of  the  system,  the 
supervention  of  an  acute  phlegmasia  involves  necessarily,  and 
in  every  case,  the  increase  of  the  fibrine  of  the  blood  beyond 
its  normal  quantity.  This  law,  too,  prevails  amongst  animals, 
as  well  as  amongst  men,  as  I  have  become  well  assured  by- 
analyzing  the  blood  of  dogs,  horses,  neat-cattle,  and  sheep,  at- 
tacked with  various  inflammations  which  had  been  discovered 
during  life,  and  after  death. 

In  man,  when  an  acute  inflammation  is  well  established,  the 
fibrine  varies  in  quantity  between  6  and  8 ;  in  a  smaller  num- 
ber of  cases  it  rises  as  high  as  between  8  and  9 ;  and,  more 
rarely  stiU,  exceeds  the  latter  number,  and  reaches  by  degrees 
lOi,  which  is  the  highest  number  I  have  yet  found  represent- 
ing the  fibrine  in  phlegmasiae  attacking  the  human  race,  though 
in  a  neat  aflected  with  pneumonia  I  found  it  as  high  as  1 3.  It 
must  be  remarked  here,  that  since  the  physiological  number 
representing  the  fibrine  in  animals  is  not  the  same  as  that  for 
man,  the  increment  in  the  former  must  not  be  judged  of  by 
the  standards  of  the  latter,  but  must  be  referred  to  the  average 
obtained  for  each  particular  class  of  animals.  Thus  the  phy- 
siological mean  of  the  fibrine  in  dog's  blood  being  only  2.1, 


68  PATHOLOGICAL  HEMATOLOGY. 

the  numbers  3,  4,  and  5  obtained  when  this  animal  was  at- 
tacked with  inflammation,  would,  in  the  case  of  man,  indicate 
a  development  of  fibrine  to  be  represented  by  much  higher 
numbers.  On  th^  other  hand,  the  physiological  mean  of  the 
fibrine  in  the  blood  of  horses  and  neat-cattle  being  greater 
than  that  of  man,  the  number  13  indicating  the  quantity  of 
fibrine  in  the  blood  of  one  of  these  animals,  would,  in  the  case 
of  man,  represent  a  much  inferior  quantity.  These  corrections 
are  indispensable,  if  we  desire  profitably  to  apply  to  human 
pathology  the  results  obtained  from  studying  the  pathology  of 
other  species. 

In  regard  to  the  cases  in  which  the  fibrine  falls  below  5, 
they  are  either  acute  and  slight  inflammations,  and  which  can 
hardly  be  said  to  have  commenced,  or  whose  activity  and  ex- 
tent are  inconsiderable  :  in  them  it  may  happen  that  the  fibrine 
falls  from  5  to  4^,  and  sometimes  even  to  4;  but  this  last 
number  represents  the  lowest  possible,  and,  as  it  were,  excep- 
tional limit,  of  the  quantity  of  fibrhie  in  the  acute  or  subacute 
inflammatory  state. 

To  demonstrate  the  sudden  change  of  composition  which 
takes  place  in  the  blood  of  persons  attacked  with  acute  phleg- 
masiee,  I  might  cite  several  cases  in  which  the  same  person 
having  been  bled,  some  days  before  the  outset  of  the  phlegma- 
sia, and  again  during  the  course  thereof,  his  blood,  which  con- 
tained the  normal  quantity  of  fibrine  at  the  first  depletion,  was 
much  more  abundantly  provided  with  it  at  the  subsequent 
ones. 

The  two  diseases  in  which  I  have  noticed  the  greatest  de- 
velopment of  fibrine,  are  pneumonia,  and  acute  articular  rheu- 
matism ;  they  are  the  only  ones  in  which  this  augmentation 
reached  the  number  10. 

I  will  now  pass  in  review  all  those  diseases,  different  indeed, 
in  seat,  but  not  in  nature,  in  which  I  have  found,  as  an  inva- 
riable characteristic,  an  increase  in  the  spontaneously  coagula- 
ble  matter  of  the  blood.* 

*  For  further  details  respecting  the  state  of  the  blood  in  these  various  dis- 
eases, see  the  two  memoirs  already  cited,  and  which  are  published  in  the 


OF  THE  BLOOD  IN  DISEASES.  69 

And  first,  since  inflammation  of  the  cellular  tissue  is  re- 
garded as  the  type  of  all  inflammation,  I  will  notice  a  case  of 
phlegmon  of  the  leg,  of  moderate  extent,  which  terminated  in 
abscess,  and  which  was  accompanied  by  a  very  slight  febrile 
reaction.     The  first  bleeding  gave  4.7  of  fibrine,  the  second  5. 

In  another  case  of  phlegmon  of  the  breast  which  terminated 
in  resolution,  the  blood  furnished  4.5  of  fibrine  during  the 
course  of  the  afiection,  and  only  3.7  at  its  close. 

Out  of  84  bleedings  performed  in  the  course  of  well  marked 
cases  of  pneumonia,  there  were  seven  only  in  which  the  fibrine 
varied  in  quantity  between  4  and  5 ;  in  the  77  others  it  ex- 
ceeded the  latter  number,  was  eleven  times  between  5  and  6, 
nineteen  times  between  6  and  7,  fifteen  times  between  7  and 
8,  seventeen  times  between  8  and  9,  nine  times  between  9  and 
10,  and  six  times  at,  or  a  little  above,  10. 

In  inflammations  of  the  mucous  membrane,  the  quantity  of 
fibrine  is  found  to  remain  normal,  if  the  inflammations  are 
slight,  limited,  and  without  fever ;  but  do  they  acquire  ever  so 
little  of  a  certain  degree  of  intensity,  and  manifest  a  febrile 
reaction,  so  surely  does  the  fibrine  of  the  blood  augment. 

Thus  I  have  seen  it  reach  6,  7,  and  9  in  cases  of  bronchitis 
of  great  extent  and  acuteness.  I  refer  to  my  first  memoir  for 
the  details  of  these  cases,  contrasted  with  others  of  chronic 
bronchitis  in  which  there  was  no  increase  of  the  fibrine.  In- 
flammations of  the  intestinal  mucous  membrane  present  the 
same  phenomena. 

I  may  here  be  permitted  to  cite,  somewhat  less  briefly,  four 
cases  of  acute  mercurial  stomatitis  which  seem  to  me  to  possess 
some  interest  due,  on  the  one  hand,  to  the  cause  producing 
them,  and,  on  the  other,  to  the  exact  ratio  which  existed,  in 
all  these  cases,  between  the  intensity  of  the  affection  of  the 
solid,  and  the  quantity  of  fibrine  in  the  blood.  These  four 
cases  have,  moreover,  never  been  published. 

In  the  first  a  slight  stomatitis  occurred  after  a  dose  of  twelve 

Annaks  de  chimie  et  de  physique,  vol.  Ixxv  of  the  2d  series,  and  vol.  v  of  the 
3d.  I  shall  here  only  notice  at  any  length  the  facts  not  published  in  these 
two  memoirs. 


70  PATHOLOGICAL  HEMATOLOGY. 

decigrammes  (18,5  grains)  of  calomel;  there  were  a  few 
pseudo-membranous  films  scattered  over  the  lining  membrane 
of  the  mouth ;  the  salivation  was  copious ;  the  pulse  80;  the 
temperature  of  the  skin  37.50.*  The  blood  contained  4.5  of 
fibrine. 

In  the  second  case  a  dose  of  only  six  decigrammes  (9.5 
grains)  of  calomel  had  given  rise  to  a  rather  more  acute  in- 
flammation of  the  mouth ;  and  there  was  more  fever.  Pulse 
100  ;  temperature  39.     The  blood  contained  5  parts  of  fibrine. 

In  the  third  case,  the  affection  followed  the  use  of  mercu- 
rial frictions  simultaneously  with  calomel  given  internally ;  it 
was  more  violent  than  the  two  preceding  cases.  Numerous 
and  thick  false  membranes  invested  the  gums,  the  lips,  and 
the  cheeks.  The  degree  of  fever  was  about  the  same  as  in  the 
second  case,  (pulse  96,  temperature  38.50,)  we  found  8.4  of 
fibrine  in  the  blood. 

,  In  the  fourth  and  last  case,  the  stomatitis,  produced  as  in  the 
last  case,  was  more  considerable,  for  the  whole  mouth  was 
enormously  swollen,  and  encrusted  with  false  membranes. 
The  pulse  was  120,  the  temperature  39.  In  this  case  the 
fibrine  rose  to  6.6,  and  its  increase  was  clearly  due  to  the  in- 
flammation ;  for  the  patient  had,  a  few  days  before,  been  bled 
for  a  slight  cerebral  haemorrhage,  and  at  that  time  his  blood 
contained  only  3.5  of  fibrine.  In  the  other  three  cases,  there 
was  no  other  affection  before  the  mercurial  sore-mouth,  which 
could  have  produced  any  modification  in  the  amount  of  fibrine 
in  the  blood. 

IVIercurial  stomatitis,  therefore,  notwithstanding  its  specific 
nature,  does  not  differ  from  ordinary  inflammations  in  its  influ- 
ence on  the  blood;  and  yet  it  has  been  asserted  again  and 
again,  that  one  of  the  eflects  of  mercury  introduced  into  the 
system  is  to  bring  about  a  state  of  dissolution  of  the  blood, 
which  is  incompatible  with  an  increase  of  fibrine.  It  is  possi- 
ble that  this  may  take  place  after  a  prolonged  use  of  the  medi- 
cine, but  assuredly  such  is  not  the  case  soon  after  its  first 

•  Probably  centigrade:  but  the  author  does  not  mention  what  thermometer 
was  used  by  him.     TV. 


OP  THE  BLOOD  IN  DISEASES.  71 

exhibition.  Consequently,  when  it  is  administered  to  combat 
certain  acute  phlegmasias,  such  as  peritonitis,  it  is  not  right  to 
assume  that  its  antiplilogistic  action  consists  in  its  producing 
in  the  blood  a  condition  opposed  to  that  which  belongs  to  the 
inflammatory  state.  Nor  do  I  find  that  this  dissolving  influ- 
ence upon  the  blood  which  is  claimed  for  mercury,  has  ever 
been  demonstrated,  in  any  alleged  case,  by  a  rigorous  exami- 
nation of  that  fluid.  It  appears  to  me  that  the  opinion  rests 
chiefly  on  a  fancied  analogy  between  the  effects  of  mercury, 
and  those  of  scurvy,  upon  the  mouth. 

But  this  is  a  deceptive  resemblance :  in  the  aflection  of  the 
mouth  following  the  administration  of  mercury,  are  to  be  ob- 
served all  the  marks  of  a  true  inflammation,  which,  if  some- 
what intense,  is  accompanied  with  active  fever.  But  the  case 
is  not  the  same  in  scurvy :  the  symptoms  which  then  show 
themselves  in  the  mucous  membrane  of  the  mouth  are  only 
amongst  the  phases  of  those  haemorrhagic  congestions  which 
are  ready  to  take  place  in  nearly  all  the  tissues. 

Proceeding  with  the  exposition  of  our  analyses  of  the  blood 
in  various  cases  of  inflamed  intestinal  mucous  membrane,  I 
find  it  to  be  uniformly  the  fact,  that  a  notable  increase  of  the 
fibrine  takes  place  whenever  any  portion  of  this  membrane, 
from  the  fauces  to  the  end  of  the  colon,  inclusive,  is  attacked 
with  inflammation  acute  enough  to  excite  fever  :  in  these  cases 
the  quantity  of  fibrine  has  reached  5,  6,  and  7,  but  never  a 
higher  degree.  We  have  already  shown  that  this  increase 
does  not  occur,  when  the  inflammation,  seated  in  the  follicles, 
exists  only  as  one  of  the  elements  of  a  general  disease,  i.  e.  of 
a  typhoid  fever. 

The  great  distinctive  traits  separating  cholera  from  proper 
inflammatory  affections  of  the  intestinal  canal,  might  have 
found  confirmation,  if  need  were,  in  a  recent  examination  I 
had  occasion  to  make  of  the  blood,  in  a  perfectly  sporadic  case 
of  this  disease.  The  patient  was  a  robust  man,  in  middle  life, 
who  entered  the  hospital  of  La  Charite  with  all  the  symptoms 
of  a  pretty  severe  attack  of  cholera  :  (copious  vomiting  and 
purging,  colourless  stools  resembling  rice  water,  cramps,  apho- 


72  PATHOLOGICAL  HEMATOLOGY. 

nia,  suppression  of  urine,  cold  skin,  but  a  pulse  of  natural  ful- 
ness, and  moderate  frequency.)  The  blood  of  this  patient 
gave  only  3.3  of  fibrine,  and  contained  only  118  parts  of  glo- 
bules, and  88  of  the  solid  constituents  of  the  serum. 

Finally,  to  close  this  review  of  the  state  of  the  blood  in  in- 
flammations of  the  mucous  membranes,  let  me  remark,  that 
the  increase  of  the  fibrine  has  not  failed  to  occur,  either  in 
various  cases  of  acute  cystitis,  whether  accompanied  or  not 
with  nephritis,  or  in  recent,  painful,  and  intense  inflammations 
of  the  utero-vaginal  mucous  membrane.  In  these  different 
cases,  which  were  all  accompanied  with  fever,  the  fibrine 
oscillated  between  4,  5,  and  7.'  I  may  mention  that  one  of 
these  cases  was  complicated  with  Bright's  disease  of  an  indo- 
lent and  apyrectic  form,  to  combat  which  I  directed  a  bleeding 
which  gave  3.6  of  fibrine.  Three  or  four  days  afterwards  an 
acute  pain  attacked  the  right  side  of  the  lumbar  region,  and 
fever  set  in.  The  patient  was  again  bled,  and  this  time  his 
blood,  suddenly  changed  in  its  composition,  contained  5  of 

fibrine. 

Inflammations  of  the  skin,  as  well  as  of  the  mucous  mem- 
branes, bring  with  them  an  increase  of  the  fibrine  of  the  blood. 
This  I  have  ascertained  in  a  person  who  had  been  severely 
burned ;  while,  on  the  other  hand,  there  was  no  increase  in 
another  whose  burn  was  slighter,  and  less  extensive. 

It  appears  to  me  peculiarly  interesting  to  determine, 
whether,  in  cases  of  burn,  the  blood  becomes  charged  with 
fibrine,  because  in  such  cases,  evidently,  the  disease  begins  in 
a  solid,  and  the  alteration  of  the  blood  can  therefore  only  be 
regarded  as  consecutive.  Further  on  I  shall  revert  to  this 
subject. 

The  course  of  erysipelas,  when  acute  and  febrile,  is  like  that 
of  a  burn,  and  shows  an  increase  of  fibrine  represented  by  the 
numbers  6  and  7.  The  pustules  of  variola,  and  the  exanthema 
of  measles  and  scarlatina,  like  the  follicular  affection  in  dothi- 
nenteritis,  exert  less  influence  upon  the  blood,  than  simple 
erysipelas. 

I  have  likewise  established  this  invariable  law  of  augmen- 


OF  THE  BLOOD  IN  DISEASES.  •        73 

I  have  likewise  established  this  invariable  law,  of  augmen- 
tation in  the  fibrine  of  the  blood,  in  regard  to  every  acute  in- 
flammation of  the  serous  membranes.  It  was,  for  instance, 
very  marked  in  a  case  of  cerebro-spinal  meningitis,  in  which, 
after  death,  I  found  the  spinal  marrow  surrounded,  in  its  whole 
extent,  by  a  sort  of  purulent  sheath,  the  pus  having  infiltrated 
the  pia  mater. 

In  pleurisy,  peritonitis,  and  pericarditis,  I  have  also  found  in 
the  blood  this  same  excess  of  spontaneously  coagulable  matter. 
These  various  cases,  24  in  number,  are  divisible  into  two 
series.  The  first  comprises  those  in  which  the  disease,  whether 
acute  or  chronic,  was  accompanied  with  fever,  and  continually 
grew  worse ;  which  suggests  the  probability  that  the  primary 
cause  of  the  disease  was  not  exhausted,  but  maintained  its 
action.  In  the  cases  belonging  to  this  series,  I  Tuiiformly 
found  an  excess  of  fibrine  in  the  blood,  its  minimum  being  4, 
its  maximum  8.4.  ' 

In  the  second  series,  other  facts  present  themselves.  The 
inflammation  seemed  to  be  suspended ;  the  pulse  lost  its  fre- 
quency ;  and  the  only  remains  of  the  disease  were  a  greater 
or  less  eff'usion  into  a  serous  cavity.  The  blood  then  ceased 
to  contain  an  excess  of  fibrine.  It  may  even  happen,  as  I  once 
saw,  that  this  principle,  although  excessive  at  the  commence- 
ment of  the  disease,  may  return  to  its  normal  proportion, 
while  yet  the  fever  persists,  but  only  after  the  prolonged  diura- 
tion  of  the  malady  has  caused  extreme  emaciation. 

The  case  referred  to  is  that  of  a  woman  attacked  with  peri- 
tonitis ;  during  the  earlier  stages  I  had  her  bled  twice ;  the 
blood  gave  5.3  and  5.4  of  fibrme.  The  peritonitis  lost  its  in- 
tensity after  this  depletion,  but  was  not  cured,  and  gradually 
passed  into  a  chronic  state.  The  patient  was  already  much 
emaciated,  when  I  endeavoured,  by  another  bleeding,  to  di- 
minish the  fever,  which  had  never  for  a  moment  ceased.  This 
time  the  blood  contained  only  3.5  of  fibrine.  After  this  bleed- 
ing, there  was  no  improvement,  and  the  patient  sunk  speedily. 
The  intestinal  convolutions  were  united  by  organized  false 
membranes,  and  the  pelvis  was  filled  with  pus.  The  tempe- 
7 


74         •  PATHOLOGICAL  HEMATOLOGY. 

rature  of  the  skin,  even  to  the  last  day,  remained  at  40°  cent., 
and  the  blood  did  not  then  contain  more  than  68  parts  of  glo- 
bules. 

In  addition  to  these  24  cases  of  serous  inflammations,  I 
should  cite  another,  in  which  the  fibrine  was  so  small  in  quan- 
tity as  to  contrast  with  all  the  other  acute  and  recent  cases. 
The  form  of  the  disease  was,  moreover,  quite  peculiar.  It  was 
seated  in  the  pleura  ;  indeed  commenced  like  a  simple  pleuro- 
dynia ;  and  then  without  any  initial  chill,  or  frequency  of 
pulse,  a  considerable  effusion  took  place  rapidly  on  one  side 
of  the  chest.  In  this  singular  case  of  pleuritic  efl'usion  without 
fever,  the  tibrine  in  the  blood  preserved  its  normal  quantity, 
(3.5).  It  may  be  doubted  whether  there  was,  in  this  instance, 
a  real  inflammatory  process.  Was  it  not  simply  hydrotho- 
rax  ?* 

There  is  a  disease  which,  in.  many  respects,  seems  to  differ 
ffom  ordinary  inflammations,  but  which,  like  them,  obeys  the 
law  relative  to  the  fibrine  of  the  blood.  I  allude  to  articular 
rheumatism.  If  acute,  the  fibrine  augments  uniformly,  as  has 
been  proved  to  me  by  an  analysis  of  43  bleedings,  in  which 
the  fibrine  was  once  represented  by  4,  six  times  by  5,  fifteen 
times  by  6,  thirteen  times  by  7,  three  times  by  S,  three  times 
by  9,  and  twice  by  10. 

But  if  the  articular  rheumatism  be  only  subacute,  there  is 
less  fibrine,  although  it  generally  exceeds  the  physiological 
quantity.     In  six  cases  of  the  sort  it  varied  between  4  and  5. 

If,  finally,  the  articular  rheumatism  be  decidedly  chronic,  the 
fibrine  returns  to  its  normal  standard. 

To  bring  this  long  catalogue  to  an  end,  I  have  yet  to  point 
out  the  modifications  of  the  fibrine  in  certain  inflammations  of 
the  parenchymatous  tissues,  regretting,  at  the  same  time,  that  I 
am  unable  to  furnish  more  cases  in  point.  But,  thus  far,  I  have 
not  had  the  opportunity  of  collecting  them. 

In  two  cases  of  acute  inflammation  of  the  lymphatic  gan- 
glia of  the  neck,  with  fever,  I  have  seen  the  fibrine  reach  4.2 

*  The  details  of,  this  case  may  be  found  in  my  first  memoir  upon  the  alte- 
rations of  the  blood,  p.  74. 


t 


OP  THE  BLOOD  IX  DISEASES.  75 

and  5  ;  one  of  these  cases  is  the  more  conclusive,  because  the 
blood  of  the  patient,  who  was  bled  for  another  reason,  two  days 
before  the  attack  of  ganglionitis,  gave  only  2  parts  of  fibrine. 

In  a  case,  proved  by  the  autopsy  to  be  acute  nephritis,  this 
element  reached  the  number  7.  ♦ 

In  conclusion,  I  give  another  illustration  of  the  state  of  the 
fibrine  in  a  case  of  softening  of  the  brain.  A  woman  was 
brought  to  the  hospital  labouring  under  a  recent  attack  of  apo- 
plexy. Her  lirribs  were  paralyzed  and  rigidly  flexed.  I  had  her 
bled,  and  was  struck  with  finding  a  larger  quantity  of  fibrine  in 
her  blood  (4.5)  than  is  usually  found  in  simple  hemorrhages. 
She  soon  died,  and  the  autopsy  disclosed,  in  the  right  corpus 
striatum,  and  around  a  clot,  a  red  softening  of  the  cerebral  sub- 
stance, of  small  extent,  but  very  distinct.  Inflammation  had, 
then,  existed  around  the  apoplectic  centre  ;  the  contraction  of 
the  paralyzed  extremities  had  indicated  it  during  life,  and  the 
excess  of  fibrine  in  the  blood  had  added  to  the  value  of  that 
sign.  It  should  also  be  remarked  here,  that  if  the  excess  of 
fibrine  was  small,  the  inflammatory  complication  was  also 
very  limited. 

Since  the  commencement  of  my  inquiries,  I  have  not  met 
with  a  single  case  of  acute  hepatitis,  a  disease  known  to  be  rare 
in  our  chmate.  I  have  several  times  analyzed  the  blood  of 
persons  aflected  with  jaundice,  but  found  no  increase  of  fibrine 
in  any  of  them ;  nor  yet  in  a  simple  case  of  hepatic  cirrhosis. 

The  increase  of  fibrine  in  the  blood  takes  place  from  the 
very  commencement  of  the  inflammatory  state.  I  have  fre- 
quently had  the  same  individual  bled  twice ;  the  first  time,  on 
the  day  previous  to  the  inflammatory  attack,  and  the  second 
time,  a  few  hours  after  its  distinctly  marked  invasion.  The 
first  time,  the  fibrme  of  the  blood  was  normal,  the  second,  in 
excess.  I  have,  thus  far,  vainly  striven  to  determine  whether 
or  not  the  composition  of  the  blood  was  modified,  before  the 
change  denoting  inflammation  appeared  in  the  solids ;  1  have 
not  succeeded,  and  my  analyses  have  proved  to  me  nothing 
more  than  the  simultaneous  origin  of  these  two  phenomena. 
This  serious  question  does  not  yet,  however,  appear  to  me  to 


76  PATHOLOGICAL  HEMATOLOGY. 

be  set  at  rest ;  a  question,  by  the  ultimate  solution  of  which 
we  must  decide,  whether  in  the  great  phenomena  of  inflam- 
mation, the  source  of  disease  is  in  the  solids,  or  in  the  blood, 
or  whether  the  alteration  of  the  one  is  not  so  essential  to  that 
of  the  other,  as  that  both  must  necessarily  begin  to  exist  at  the 
same  moment.  Remark,  too,  what  a  variety  of  beghmings 
belong  to  the  diseases  ranked  as  inflammations  :  at  one  time 
there  is  no  interval  between  a  state  of  perfect  health,  and  the 
invasion  of  the  disease ;  at  another,  there  is  a  general  uneasi- 
ness, and  that  slight  disturbance  of  all  the  functions  which  we 
call  the  "  prodrome"  of  diseases ;  at  another,  a  well  marked 
fever  sets  in,  from  one  to  three  days  before  the  appearance  of 
symptoms  denoting  a  phlegmasia  of  some  one  of  the  solids. 
But  even  where  the  disease  comes  on  without  any  "  prodrome," 
it  may  do  so  in  one  of  three  ways :  either  there  is  pain,  a 
purely  local  symptom,  to  open  the  attack,  while  the  rest  of  the 
economy  seems  unaffected  by  the  local  disorder ;  or  before 
this  latter  is  felt,  there  may  be  a  violent  chill  as  the  only  appre- 
ciable morbid  phenomenon,  and  which  may  last  for  half  an 
hour,  for  an  hour,  or  even  longer ;  or  else  the  local  symptom 
and  the  chill  may  appear  simultaneously.  I  ought  to  add  that 
this  last  case  is  more  common  than  the  two  others.  We  may 
well  inquire  whether,  when  its  earliest  symptoms  are  so  dif- 
ferent, the  starting  point  of  inflammation  is  always  the  same. 
That  which  takes  place  in  the  case  of  a  burn  proves  very 
clearlyt  hat,  under  the  circumstances,  the  blood  is  modified 
in  its  composition  subseqviently  to  the  alteration  of  the  solid, 
and,  inferentially,  we  may  suppose  that  it  must  be  so  in  all 
other  inflammations.  The  analyses  of  the  blood  hitherto  made 
would  tend  to  confirm  this  view,  for  they  have  never  revealed 
an  excess  of  fibrine  in  the  blood,  before  the  occurrence  of  in- 
flammatory symptoms  in  the  solids.  On  the  other  hand,  there 
are  certainly  cases  in  which  the  sensible  alterations  of  the  lat- 
ter are  so  inconsiderable,  so  variable,  and  sometimes  so  ephe- 
meral, that  it  is  difficult  to  understand  how  they  can  be  the 
cause  of  such  intimate  and  enduring  changes  as  have  then 
taken  place  in  the  blood.     Is  it  not  often  so  in  articular  rheu- 


OF  THE  BLOOD  IN  DISEASES.  77 

malism,  and  is  it  not  remarkable  tliat  this  is  one  of  the  diseases 
remarkable  for  increase  of  fibrine  ?     In  all  this  there  are  un- 
known quantities  to  determine  :  there  is  yet  to  be  discovered 
that  mysterious  link,  whose  necessity  is  proved  by  its  con- 
stancy, and  which,  in  the  phlegmasise,  unites  the  alteration  of 
the  solids  v/ith  that  of  the  blood.     Yet,  from  the  simultaneous 
character  of  these  alterations,  the  deduction  may  still  be  made, 
that  what  we  call  inflammation  is  not  a  disease  seated  in  the 
solids  merely,  that  it  does  not  influence  the  rest  of  the  economy 
only  by  pretended  s^pathetic  radiations,  and,  that  in  all  these 
things,  the  changes  which  are  then  taking  place  in  the  blood, 
play  an  important  part.  An  inflammation,  then,  is  not  a  purely 
local  disease.     Does  the  fever  which  accompanies  every  acute 
phlegmasia  of  some  intensity  depend  upon  the  excess  of  fibrine 
contained  in  the  blood  ?*     Observe  that  there  is  stiU  an  almost  ♦ 
constant  and  reciprocal  relation  to  be  studied,  between  these 
two  facts ;  for,  as  the  fever  begins,  the  fibrine  increases,  and 
as  the  fever  ceases,  the  fibrine  returns  to  its  normal  condition, 
yet  the  local  lesion  may  still  persist  with  considerable  acti- 
vity.    How  many  times,  for  instance,  have  I  not  continued 
to  find,  by  auscultation,  the  most  perfectly  distinct  signs  of 
pulmonary  hepatization,  when,  for  several  days  before,  all 
fever,  and  every  appearance  of  reaction  between  the  lung  and 
the  system,  had  completely  disappeared;  so  completely,  that 
but  for  auscultation,  one  might  have  believed  the  disease  at 
an  end.    And  indeed  it  was  so,  in  this  sense,  that  the  lesion  of 
the  lung  was  only  the  result,  and  almost  an  unimportant  one, 
of  a  morbid  action  that  had  ceased ;  thenceforth  the  fever  also 
ceased,  and  the  production  of  new  fibrine,  the  index  of  this 
process  in  the  blood,  no  longer  took  place.     The  disease  had 
once  more  become  entirely  local,  if  indeed  such  a  condition  of 
the  lung  deserves  the  name  of  disease.     It  would  be  said,  in 
the  language  of  some  of  the  schools,  that  the  diathesis  no  longer 

•  At  any  rate  we  should  be  able  to  explain  only  the  symptomatic  fever  of 
acute  phlegmasia;,  in  this  way;  for  in  the  pyrexiae  the  fever  is  long,  and  in- 
tense, without  there  being  an  excess  of  fibrine  in  the  blood. 

n* 


78  PATHOLOGICAL  HJEMATOLOGT. 

existed.  But  what  is  meant  by  this  expression?  To  point 
out  the  existence  of  a  general  condition  of  the  system  of 
the  same  nature  as  the  local  lesion,  and  which  causes  the 
whole  organism  to  share  the  suffering  of  one  of  its  parts. 
There  is  not,  says  Tommasini,  an  inflammation,  properly  so 
called,  without  the  production  of  a  diathesis ;  a  local  irritation 
caused  by  a  thorn  run  into  the  finger,  does  not,  according  to 
this  author,  become  an  inflammation,  unless,  in  consequence 
of  this  very  circumscribed  lesion,  the  sthenic  diathesis  should 
be  established ;  and  it  is  established,  he  #dds,  by  the  diffusion 
of  the  phlogosis  of  the  vessels  around  the  injured  point,  to  those 
of  the  rest  of  the  body.  This  theory  is  nothing  more  than  the 
emphatic  announcement  of  the  important  fact  that  the  whole 
organism  participates  in  the  morbid  operations  which  seem 
confined  to  a  single  one  of  its  points.  Who  does  not  see,  that 
in  other  words,  and  in  another  aspect,  it  is  this  same  fact  upon 
which  is  founded  the  law  requiring  the  production  of  new 
fibrine  in  the  blood,  as  soon  as  any  solid  becomes  the  seat  of 
an  inflammation  intense  enough  to  give  rise  to  more  than 
what  Tommasini  calls  a  simple  irritation  ?  Is  not  the  excess 
of  fibrine  then  produced,  the  material  representative,  as  it  were, 
of  what  Tommasini  terms  the  diffusion  of  phlogosis  ?  Thu(s 
it  is  that  we  reach  the  same  conclusion,  in  spite  of  the  sugges- 
tions of  different  theories,  and  of  opposite  methods  of  observa- 
tion. 

The  formation,  then,  of  an  excess  of  fibrine  in  the  blood  is 
uniformly  the  accompaniment  of  inflammations  of  a  grade 
high  enough  to  give  rise  to  fever;  but  this  fact  acquires  a 
greater  importance  both  as  a  diagnostic  sign,  and  as  an  element 
of  the  doctrine  which  relates  to  the  production  of  disease,  if 
we  reflect  that  it  never  takes  place  unless  an  inflammation 
exists  somewhere.  An  excess  of  fibrine  in  the  blood  becomes, 
therefore,  a  pathognomonic  sign  of  such  inflammation. 

There  is,  however,  a  circumstance,  occurring  even  during 
health  both  in  man  and  the  lower  animals,  which  has  the 
power  of  augmenting  the  proportion  of  fibrine  contained  in  the 
blood ;  I  allude  to  gestation.     But  this  augmentation,  which  is 


OF  THE  BLOOD  IN  DISEASES.  79 

found  only  at  certain  epochs  of  pregnancy,  is  rather  a  high 
physiological  maximum,  than  even  the  ordinary  degree  of 
pathological  increase.  Tiie  following  are  the  results  obtained 
by  M.  Gavarret  and  myself  from  analyzing  the  blood  of  34 
pregnant  woman. 

From  the  first  to  the  end  of  the  sixth  month,  the  blood  con- 
tained  less  than  its  average  physiological  proportion  of  fibrine  ; 
the  mean  of  the  fibrine  during  the  first  six  months  being  only 
2.5;  its  minimum  1.9;  and  its  maximum  only  2.9. 

On  the  other  hand,  during  the  last  three  months  of  preg- 
nancy, the  mean  of  the  fibrine  exceeded  the  physiological 
mean  ;  it  reached  4,  and  the  maximum  rose  to  4.8. 

And,  further,  it  was  found  that  the  increase  of  the  fibrine 
had  become  greatest  in  the  last  month  of  pregnancy ;  at  this 
period  its  mean  was  4.3 ;  its  maximum  was  not  reached  until 
the  access  of  labour,  and  it  may  be  presumed  that  this  maxi- 
mum was  maintained,  if  not  exceeded,  for  some  time  after 
delivery.  It  seems  to  me  that  this  presumption  is  supported 
by  the  results  which  I  obtained  with  MM.  Gavarret  and 
Delafond,  by  analyzing  the  blood  of  sheep  and  cows  during 
their  gestation,  and  again  after  they  had  brought  forth;  at 
which  latter  time  these  animals  furnished  more  fibrine  than 
before.  (See  the  Memoir  upon  the  composition  of  the  blood 
ill  certain  domestic  animals.) 

It  is  then  demonstrated  that  in  women,  at  particular  periods 
of  gestation,  and  in  cows  and  sheep,  after  parturition,  the 
blood  contains  a  certain  excess  of  fibrine.  The  blood,  on 
these  occasions,  shows  a  remarkable  tendency  to  assume  the 
character  of  inflammatory  blood ;  and,  assuredly  there  is  mat- 
ter for  reflection  in  the  relation  which  may  exist  between  the 
modification  then  effected  in  the  blood,  and  the  development 
of  those  peculiar  attacks,  generally  of  an  inflammatory  aspect, 
to  which  women  in  childbed  are  so  liable.  But  ought  the  slight 
excess  of  fibrine  in  their  blood,  at  that  time,  to  be  regarded  as 
a  predisposing  cause  of  these  attacks  ?  If  so,  this  would  be 
such  a  case  as  I  recently  sought,  (and  observation  has  not  yet 
furnished  me  with  any  other)  in  which  the  proper  inflamma- 


80  PATHOLOGICAL  HEMATOLOGY. 

lory  alteration  of  the  blood  precedes  the  signs  of  inflammation 
in  the  solids. 

If  in  the  later  periods  of  pregnancy  the  blood  contains  rather 
more  fibrine  than  in  other  states  of  health,  we  may  understand 
how  it  happens,  that  when  blood  is  drawn  from  a  certain  pro- 
.  portion  of  pregnant  women,  its  clot  should  be  covered  with  a 
buffy  coat ;  and  this  should  occur  the  more  readily  in  them, 
because  the  amount  of  globules  in  their  blood  often  falls  more 
or  less  below  the  normal  standard.  Thus,  of  34  pregnant 
women  whose  blood  we  examined,  in  one  only  who  had 
reached  the  end  of  her  second  month,  did  the  globules,  (145) 
"exceed  the  physiological  average;  this  woman  was  plethoric, 
and  the  quantity  of  her  fibrine  was  only  2.8.  In  another  case 
of  pregnancy  of  from  one  to  two  months,  the  globules  reached 
exactly  the  normal  average,  127.  But  in  the  32  others,  they 
fell  below  this  point,  varying  in  six  cases  from  125  to  120,  and 
in  the  26  other  cases  from  120  to  95  ;  whence  it  follows  that 
there  was  a  commencement  of  anaemia  in  all  these  women. 
This  state  of  the  blood,  is  also  perfectly  in  keeping  with  the 
remarkable  pallor,  and  the  degree  of  puffiness  of  the  face,  which 
many  women  exhibit,  as  soon  as  they  have  conceived.  Preg- 
nancy, then,  which  has  often  been  looked  upon  as  a  cure  for 
chlorosis,  rather  disposes  some  women  to  the  affection  while 
that  state  lasts.' 

But  enough  about  this  subject,  upon  which  I  have  entered 
here  only  that  I  might  render  prominent  the  curious  analogy 
that  exists  between  the  blood  of  pregnant  women,  and  that  of 
persons  attacked  with  acute  inflammations. 

Before  concluding  our  notice  of  the  state  of  the  blood  in  in- 
flammation, I  wish  to  direct  the  attention,  for  a  few  minutes,  to 
the  nature  of  those  alterations  which  may  occur  in  the  solids. 
These  products  are  either  the  natural  secretion  of  the  inflamed 
part,  modified  both  in  quality  and  quantity,  or  else  pus,  or  some 
of  the  elements  of  the  blood  itself  I  shall,  in  this  place,  allude 
only  to  the  third  form. 

The  two  principal  elements  of  the  blood  which  are  the  most 
frequently  separated  from  it,  in  inflammation,  are  albumen  and 


w^ 


OF  THE  BLOOD  IN  DISEASES.  81 

fibrine.  But  although  the  albumen  of  the  serum  may  be  given 
up  by  the  blood  in  many  conditions  of  disease  which  have  no 
connection  with  inflammation,  such  is  not  the  case  with  the 
fibrine,  which  does  not  leave  the  blood,  in  disease,  except  to 
be  deposited  in  the  tissue,  or  upon  the  surface,  of  organs 
whose  texture  has  been  altered  by  inflammation. 

The  serum  contained  in  an  inflamed  solid,  moreover,  as  well 
as  that  which  is  separated  from  the  blood  under  any  other  cir- 
cumstances, never  exactly  resembles  the  serum  of  the  blood, 
in  the  proportion  of  albumen  it  contains.  It  may  be  laid  down 
as  a  general  principle  that  morbid  secretions  of  serum,  what- 
ever be  their  origin,  are  rarely  as  rich  in  albumen,  as  the  serum 
of  the  blood ;  but,  other  things  being  equal,  those  which  most 
closely  resemble  the  serum  of  the  blood  in  the  quantity  of 
albumen  they  contain,  sometimes  even  equalling  the  propor- 
tion contained  in  that  fluid,  are  such  as  are  exhaled  from  in- 
flamed surfaces.  I  shall  demonstrate  this  in  a  subsequent 
article  upon  the  state  of  the  blood  in  dropsies. 

I  have  also  endeavoured  to  discover  how  much  albumen 
was  contained  in  another  variety  of  serum,  that  of  a  conges- 
tive abscess,  and  which  had  suspended  in  it  a  large  quantity  of 
pus-globules.  To  the  naked  eye  this  liquid  appeared  turbid, 
and  of  a  milky  hue  ;  but  by  filtering,  we  easily  deprived  it  of 
the  globules  that  diminished  its  transparency,  and  then  we  ob- 
tained a  liquid  so  perfectly  resembling  pure  serum  in  all  its 
physical  properties,  as  not  to  be  distinguishable  from  it.  This 
liquid,  thus  deprived  of  the  matters  suspended  in  it,  we  sub- 
jected to  the  ordinary  processes,  and  found  that  it  contained  a 
proportion  of  albumen  nearly  equal  to  what  exists  in  the 
healthy  blood ;  a  result  confirmatory  of  the  principle  just  now 
laid  down. 

Wc  learn,  besides,  from  this  experiment,  that  a  portion  of 
the  liquid  furnished  by  an  inflamed  solid  is  nothing  more  than 
the  serum  of  the  blood,  with  which  is  mixed  a  greater  or  less 
number  of  those  singular  bodies  called  pus-globules. 

Thus,  one  efl'ect  of  the  morbid  process,  called  inflammation, 
is  to  deprive  the  blood  of  a  certain  portion  of  its  serum ;  the 


iras 


82  PATHOLOGICAL  HEMATOLOGY. 

latter,  as  may  be  conceived,  is  not  then  altered  in  its  essential 
nature,  but  undergoes  a  change  of  aspect  dependent  upon  the 
admixture  with  it  of  two  new  bodies;  a  principle  (fibrine) 
which,  like  the  serum  itself,  is  an  emanation  of  the  blood,  and 
of  a  matter  (pus)  which,  as  regards  its  physical  properties, 
at  least,  has  nothing  like  it  in  the  blood. 

This  process,  then,  whoise  nature  is  wholly  unknown,  and 
which  cannot  be  accomplished,  without  the  blood  is  over- 
charged with  fibrine,  determines,  whenever  it  takes  place,  the 
elimination  of  a  certain  quantity  of  fibrine.  But  this  elimina- 
tion is  not  always  distinct;  it  is  especially  observed, and  in  the 
most  evident  manner,  either  in  the  serum  formed  upon  the 
skin  by  the  action  of  cantharides,  or  in  that  which  fills  the 
cavities  of  inflamed  serous  membranes. 

It  is  not  only  at  this  day  that  the  spontaneously  coagulable 
matter  found  in  these  liquids  has  been  considered  fibrinous  ; 
but  there  was  no  ground  for  its  being  so  called,  other  than  its 
property  of  becoming  solid.  To  demonstrate  that  this  sub- 
stance was  really  fibrine,  I  adopted  another  method  of  investi- 
gation :  I  examined,  under  the  microscope,  the  flakes  which  the 
serum  holds  suspended,  and  also  the  yet  soft  false  membranes 
lining  the  free  surface  of  inflamed  serous  membranes,  and 
found,  in  both  instances,  a  net-work  precisely  similar  to  that 
presented  by  the  fibrine  of  the  blood,  and  which  has  already 
been  described.  Thenceforth  I  no  longer  doubted  that  the 
flake-like  matter  which  swims  in  the  liquid  produced  by  blis- 
ters, and  the  false  membranes  .of  serous  tissues,  were  really 
composed  of  a  substance  perfectly  analogous  to  the  fibrine  of 
the  blood. 

I  have  not  yet  had  an  opportunity  of  determining  whether 
or  not  this  net-work,  which  is  so  characteristic  of  the  presence 
of  fibrine,  is  to  be  found  in  the  pseudo-membranous  layers 
which,  in  certain  cases,  cover  the  mucous  membranes.  To 
the  naked  eye,  these  concretions  are  far  from  resembling  the 
serous  false  membranes,  and  it  may  be,  that  under  the  influ- 
ence of  some  pathological  action,  other  principles,  besides  the 
fibrine,  acquire  the  property  of  coagulability.     Who  knows 


OP  THE  BLOOD  IN  DISEASES.  83 

how  far  the  habitual  acidity  of  the  mucous  membranes,  and 
of  the  skin,  may  favour  this  coagulation  of  the  albuminous 
principles  which  are  thrown  upon  the  free  surface  of  these 
organs,  either  accidentally,  or  in  consequence  of  disease  ? 

But  what  is  the  nature  of  pus,  and  the  mode  of  its  forma- 
tion? It  is  very  difficult  to  resolve  these  questions  in  the 
present  state  of  science.  I  cannot  admit,  as  has  been  main- 
tained by  some,  that  the  globules  of  pus  are  a  transformation 
of  those  of  the  blood ;  there  is  such  a  difference  in  their  very 
nature,  that  if  a  little  ammonia  be  added  to  a  mixture  of  pus 
and  blood  placed  in  the  field  of  a  microscope,  the  globules  of 
the  blood  are  seen  to  disappear,  while  the  globules  of  pus  are 
in  no  wise  changed.  Nor  is  the  pus  formed  at  the  expense  of 
the  serum,  the  albumen  of  which  is  foimd  unchanged,  the 
pus  being  merely  suspended  in,  without  being,  the  least  in  the 
world,  confused  with  it.  If  a  mass  of  pus  be  treated  with 
nitric  acid  or  alcohol,  granite-like  plates  are  seen,  by  the  micro- 
scope, to  form,  just  as  in  all  serum  treated  in  the  same  way, 
but  the  pus-globules  undergo  no  change.  May  not,  then,  the 
pus-globules  be  nothing  more  than  a  modification  of  fibrine, 
which,  instead  of  reaching  the  net-work  form,  has  remained  in 
the  serum  in  that  state  of  granular  corpuscles,  whose  origin 
and  nature  I  have  already  pointed  out  ?  May  not  these  cor- 
puscles, grouping  themselves  together  with  a  certain  regularity, 
produce  the  globules  of  pus  ?  Shall  I  say,  in  favour  of  this 
view,  that  on  examining  with  the  microscope  the  sero-fibri- 
nous  liquid  separated  from  the  blood-globules  by  means  of  sul- 
phate of  soda,  I  happened,  more  than  once,  to  see  the  corpus- 
cles that  were  swimming  in  the  liquid,  arrange  themselves  in 
little  masses  which  appeared  to  me  to  have  the  most  perfect 
resemblance  to  pus-globules?  It  would  have  been  quite  im- 
possible to  show  any  difference  between  them.  And  further, 
in  the  microscopic  examinations  of  pus,  not  only  are  volumi- 
nous and  regular  globules  observed,  but  alongside  of  them  is 
seen  a  large  number  of  little  molecules  precisely  like  those 
which  swim  in  the  scrum  of  the  blood,  and  which  evidently 
approach  one  another,  unite  together,  and  at  last  become  ag- 


84  PATHOLOGICAL  HJEMATOLOGT. 

gregated  in  rounded  masses.  If  finally,  we  examine  atten- 
tively a  well  formed  globule  of  pus,  it  appears  to  be  made  up 
of  a  collection  of  globules  placed  in  juxtaposition,  rather  than 
blended.  It  is  not,  certainly,  a  body  formed  in  a  single  piece, 
and  constituting  a  perfectly  homogeneous  whole,  like  the  glo- 
bules of  the  blood. 

Thus  two  substances  are  revealed  by  the  microscope,  the 
one  globular,  the  other  reticular,  which  characterize  the  pre- 
sence of  the  morbid  process,  termed  inflammation,  in  the 
solids.  The  reticular  substance  is  nothing  more  than  fibrine 
identical  with  that  of  the  blood ;  the  globular  substance  is  per- 
haps this  same  fibrine,  but  altered  in  its  nature,  and  arrested 
in  its  coagulation.  These  two  matters  have,  moreover,  very 
different  destinies.  One  of  them,  the  reticular,  is  capable  of 
assuming  organization;  vessels  may  be  seen  to  ramify  in  it; 
it  may  become  a  tissue ;  this  it  is  which  forms  adhesions,  or 
which,  under  the  name  of  coagulable  lymph,  places  itself  be- 
tween the  lips  of  wounds  and  becomes  the  medium  of  their 
union ;  far  from  causing  injury  by  its  presence,  it  is,  then,  in 
certain  cases,  the  means  of  reparation  to  the  tissues,  and  to  that 
end  it  lives  with  their  life,  and  ends  by  identifying  itself  wholly 
with  them.  But  such  is  not  the  case  with  the  globular  mat- 
ter. Whether  or  not  it  have  a  common  origin  with  that  last 
mentioned,  certain  it  is,  that  it  constitutes  a  product  which  can- 
not remain  within  the  solids  without  affecting,  more  or  less,  the 
whole  economy  ;  it  is  incapable  of  organization,  and  reveals 
no  trace  of  vitality.  While  the  organism  tends,  in  some  sort, 
to  assimilate  to  its  own  proper  use  the  reticular  substance,  and 
employs  it  to  repair  the  mischief  it  originally  caused,  it  strives, 
on  the  contrary,  to  expel  the  globular  matter,  whose  presence 
is  pernicious ;  so  long  as  it  is  not  eliminated  the  disease  per- 
sists, and  this  elimination  itself  is  not  always  effected  without 
serious  accidents.  But  can  the  globular  matter,  instead  of 
being  merely  expelled,  and  after  having  been  conducted  more 
or  less  rapidly  to  those  surfaces  in  direct  communication  with 
the  exterior  of  the  body,  disappear  from  the  place  where  it 
was  formed,  and  enter  directly  into  the  circulatory  torrent  ? 


OP  THE  BLOOD  IN  DISEASES.  85 

Ifis  not  easy  to  understand  how  such  large  globules  as  those 
of  pus  can  penetrate  in  mass,  by  a  sort  of  endosmosis,  through 
the  coats  of  the  vessels ;  at  the  most,  they  could  traverse  them 
only  in  fragments,  and,  as  it  were,  in  ruins.     But  once  received 
into  the  blood  could  they  again  unite,  and  re-form  new  glo- 
bules ?     I  do  not  wish  to  exhaust  this  question ;  and  indeed 
I  do  not  think  it  can  be  resolved  by  the  facts  we  at  present 
possess.     Still,  I  will  say  that  the   presence  of  pus-globules 
in  the  circulating  fluid,  appears  to  me,  after  what  I  have 
seen,  a  fact  that  can  in  no  wise  be  contested.     I  have  found, 
more  than  once,  in  the  midst  of  blood-globules  taken  from  the 
vessels  of  dead  bodies,  globules  of  pus,  well  formed,  and  so 
distinctly  characterized  that  they  could  not  possibly  be  taken 
for  any  thing  else.     They  were,  certainly,  neither  altered  glo- 
bules of  blood  either  jagged  or  granulated,  nor  those  white 
globules  which  are  found  mixed  with  the  ordinary  red  ones, 
and  which,  besides,  could  not  be  confounded  with  globules  of 
pus.     The  following  cases  are  those  in  which  I  met  with  them. 
The  first  is  that  of  a  person  who  was  brought,  dying,  into 
the  hospital  of  La  Charite,  and  in  a  very  marked  ataxo-ady- 
namic  state.     At  the  dissection  I  found  very  numerous  ab- 
scesses in  the  brain,  the  lungs,  the  kidneys,  and  the  spleen. 
The  blood  was  everywhere  either  quite  liquid,  or  grumous, 
and  like  thin  currant-jelly.     I  collected  a  small  quantity  of 
blood  from  the  crural  vein  for  examination  by  the  micro- 
scope ;  in  the  midst  of  a  great  many  disfigured  and  granu- 
lated globules  of  blood,  (for  such  is  their  ordinary  condition  in 
the  dead  body,)  a  considerable  number  of  pus-globules  could 
be  very  distinctly  made  out.     There  was  nowhere  the  least 
trace  of  phlebitis.     This  is  one  of  the  cases  which  the  older 
writers  would  have  designated  under  the  name  of  purulent 
diathesis.     Collections  of  pus  in  several  of  the  solid  organs, 
and  pus  in  the  blood,  were  in  reality,  the  only  lesions  that 
could  be  detected. 

In  another  case  I  found  pus  in  the  blood  under  the  following 
circumstances.     A  labourer  had  been  wounded  by  a  violent 
blow  on  the  leg.     He  survived  this  accident  but  three  days, 
8 


86  PATHOLOGICAL  HEMATOLOGY. 

and  died  after  an  intense  fever,  with  delirium,  to  which  suc- 
ceeded great  prostration,  and  coma.  The  veins  in  the  neigh- 
bourhood of  the  wound  offered  nothing  worthy  of  remark ; 
but  the  crural  vein  was  filled  with  coagulated  blood,  without, 
however,  its  parietes  presenting  any  notable  alteration.  Ex- 
amined by  the  microscope,  this  blood  showed  very  small  glo- 
bules, and  yet,  among  them  could  be  discerned,  here  and 
there,  globules  of  pus  as  perfect  as  could  have  been  found  in 
an  abscess.  In  the  other  portions  of  the  vascular  system,  the 
blood  offered  no  peculiarities,  either  to  the  naked  eye,  or  to  the 
microscope.  The  mguinal  glands  upon  the  injured  side  were 
swelled  and  suppurating. 

I  will  cite  still  another  case,  that  of  a  woman  who  died  at 
La  Charite  in  consequence  of  a  vast  psoas  abscess.  Indepen- 
dently of  this,  I  discovered  the  following  lesions :  numerous 
puriilent  collections,  like  those  called  metastatic,  were  in  both 
lungs :  the  coats  of  the  right  crural  vein  were  uncommonly 
thick,  carnified,  as  it  were,  and  their  internal  surface  rugose 
and  uneven.  The  blood  filling  this  vein  resembled  sanies, 
and  the  microscope  revealed  in  it  a  large  quantity  of  pus-glo- 
bules. But,  in  addition,  these  globules  existed  in  the  blood  of 
the  heart ;  a  great  number  of  them  was  found  in  the  fluid 
blood  of  the  right  ventricle,  and  they  were  again  met  with, 
but  in  much  smaller  number,  in  the  blood  of  the  left  ventricle, 
which  was  also  fluid.  A  very  small  fibrinous  concretion  was 
entangled  in  the  columnse  carnese  of  this  ventricle  ;  in  those  of 
the  right  ventricle  a  membraniform  web  was  interwoven,  such 
as  is  found  in  the  heart  after  all  varieties  of  diseases,  and  deaths, 
and  which  is  nothing  more  than  a  deposit  of  fibrine  spread  out 
like  a  membrane,  as  it  is  sometimes  upon  the  surface  of  con- 
cretions. If  I  speak  of  it  here,  it  is  for  the  purpose  of  showing 
what  degree  of  coagulability  this  pus-infected  blood  retained, 
and  because  I  examined  this  sort  of  false  membrane  with  the 
microscope,  and  found  it  constituted,  like  all  fibrinous  produc- 
tions, by  a  very  beautiful  net-work,  in  whose  meshes  were 
imprisoned  globules  of  blood  and  of  pus,  as  perfectly  distinct 
from  one  another,  there,  as  elsewhere.     In  this  case,  too,  where 


OP  THE  BLOOD  IN  DISEASES.  87 

blood  and  pus  were  mixed  together  at  such  different  points  of 
the  circulatory  system,  I  did  not  find  the  globules  of  blood  dif- 
fering either  in  number  or  general  aspect,  in  form  or  size,  from 
what  they  usually  are  in  dead  bodies. 

These  three  cases  prove  clearly  that  pus,  in  the  form  of  glo- 
bules, can  circulate  with  the  blood  in  the  vessels,  and  even 
pass  through  the  lungs  from  the  right  to  the  left  side  of  the 
heart.  It  seems  to  me  very  evident  that  it  was  so  in  the  last 
case  :  the  greater  part  of  the  globules,  urged  from  the  venous 
system  into  the  pulmonary  artery,  stopped  in  the  ultimate 
ramifications  of  this  artery ;  whence  the  numerous  abscesses 
that  existed  in  the  lungs ;  but  some  of  them  were  able  to  enter 
the  pulmonary  veins,  and  reach  the  left  side  of  the  heart 
where  I  detected  them. 

In  these  various  cases,  the  globules  of  pus  appeared  to  me 
to  remain  as  distinct  from  those  of  the  blood,  as  they  are  when 
artificially  mixed  together  in  a  vessel.  I  have  often  tried  this 
experiment,  and  can  give  my  assurance,  that  unless  too  little 
pus  be  mingled  with  the  blood,  the  pus,  on  examination  with 
the  microscope,  will  be  found  to  exist  in  it,  under  the  form  of 
well  preserved  globules :  these  even  seem,  in  most  cases,  to 
unite  together  under  the  influence  of  a  sort  of  attraction,  so  as 
to  form  little  groups  apart  from  the  blood-globules,  which  do 
not  appear  to  be  in  the  least  altered  by  the  admixture.  I  have 
also  determined  by  experiment,  that  on  mingling  directly  pus 
with  blood,  the  latter  suffers  no  change  appreciable  by  the 
naked  eye,  or  by  the  microscope,  nor  any  in  the  amount  of  its 
fibrine,  so  long  as  the  pus  is  fresh.  But  such  is  not  the  case 
when  pus,  long  separated  from  the  body  and  partially  decom- 
posed, is  mingled  with  blood ;  then  the  blood  undergoes  re- 
markable modifications,  both  in  its  appearance,  and  in  its 
intimate  structure,  as  the  following  experiment  shows. 

I  left  to  itself,  from  June  6th  1842,  to  the  12th  of  the  same 
month,  some  grumous  pus  furnished  by  a  cold  abscess.  It  re- 
mained for  six  days,  in  the  sun,  exposed  to  a  high  temperature. 
At  the  end  of  this  time  it  diffused  a  putrid  odour,  and  had  black- 
ened the  diachylum  which  covered  the  vessel  containing  it. 


88  PATHOLOGICAL  HEMATOLOGY. 

1  then  had  bled  a  patient  suffering  from  acute  articular  rheu- 
matism, and  divided  tlie  blood  into  three  equal  portions.  I 
mixed  with  the  first  its  tenth  part  of  the  pus  which  had  been 
kept  for  six  days,  and  the  whole  was  beaten  togetlier  to  extract 
the  fibrine. 

Tlie  second  portion  was  left  to  itself,  for  twenty-four  hours, 
without  admixture  of  pus.  At  the  end  of  this  time  it  pre- 
sented a  well  formed  coagulum  covered  with  a  thick  buffy 
coat,  and  surrounded  by  colourless  serum.  From  the  first  and 
second  portions  I  extracted  the  same  quantity  of  fibrine,  viz. 
ToVo-  The  solid  part  was  even  a  little  greater  in  the_ first,  on 
account  of  the  pus  which  had  been  added  to  it. 

Finally  the  third  portion  of  blood  was,  like  the  first,  mixed 
with  its  tenth  part  of  the  same  pus,  and  then  left  alone.  '  An 
hour  after  this  admixture  I  found  a  well  formed  coagulum,  but 
without  buffy  coat,  and  surrounded  with  transparent  serum. 
The  pus,  putrid  as  it  was,  seemed,  then,  to  have  had  no  pecu- 
liar action  on  the  blood,  (unless  indeed  it  prevented  the  forma- 
tion of  a  buffy  coat,)  it  had  not  diminished  its  consistence. 

But  at  the  expiration  of  twenty-four  hours,  the  condition  of 
things  had  changed:  the  vessel  was  filled  with  a  reddish  liquid 
matter,  like  that  obtained  by  adding  ammonia  to  blood.  There 
was  no  solid  substance  in  this  blood,  except  some  fragments  at 
the  bottom  of  the  vessel,  and  which  together  were  hardly 
equal  to  a  twentieth  of  the  original  clot.  When  subjected  to 
the  microscope,  this  liquid  mass  showed  no  traces  of  blood- 
globules  ;  but  a  large  number  of  pus-globules  was  found  in . 
it,  so  that  putrefaction  had  not  destroyed  these  latter.  Jn  the 
fragments  forming  the  dthris  of  the  clot,  pus-globules  were 
also  discovered,  together  with  some  remnants  of  blood-globules 
irregular  in  form,  and  of  diminutive  size.  In  these  remains  of 
the  clot,  the  fundamental  character  of  the  fibrine  was  not  lost, 
for  the  microscope  revealed  in  it  a  net-work  of  fibres. 

It  is  now  proper  that  I  should  add,  that  having  in  other  ex- 
periments, mingled  with  blood  a  tenth  part  of  recent  pus,  taken 
from  abscesses  one  or  two  hours  before,  and  distinctly  alkaline, 
in  twenty-four  hours  I  found  the  blood  entirely  coagulated, 


OP  THE  BLOOD  IN  DISEASES.  89 

and  in  no  apparent  manner  differing  from  another  portion  of 
the  same  blood  simply  left  to  itself  during  twenty-four  hours. 
These  two  portions  of  blood  furnished  me  the  same  quantity 
of  fibrine. 

It  is  a  clear  deduction  from  these  experiments,  that  the  in- 
fluence of  pus  upon  the  blood  is  far  from  being  the  same  when 
the  pus  is  fresh,  as  when  it  has  been  long  enough  withdrawn 
from  the  living  body,  to  have  become  putrid.  Fresh  pus  has 
no  appreciable  action  upon  the  blood;  putrefied  pus  acts  like 
ammonia  upon  the  blood,  destroying  at  the  same  time  both 
globules  and  fibrine.  But  it  is  remarkable  that  this  destruction 
does  not  take  place  immediately.  The  contact  must  have 
lasted  several  hours  before  the  blood  begins  to  present  any 
traces  of  alteration. 

These  results  should  incline  us  to  believe,  that  in  cases  of 
disease  where  pus  happens  to  circulate  in  the  blood,  the 
changes  which  the  latter  may  experience  in  its  constitution  will 
vary  according  to  the  qualities  of  the  pus  which  may  chance 
to  mix  with  it:  if  recent,  the  pus  will  leave  the  blood  un- 
harmed ;  if  already  old,  and  altered  itself,  it  may  become  so 
potent  a  cause  of  disturbance  to  the  blood,  as  to  extinguish 
life  suddenly  and  inevitably.  But  it  is  very  remarkable  that 
even  in  the  second  case,  it  is  not  the  globules  of  pus  which 
appear  to  affect  the  blood  injuriously ;  I  am  much  more  dis- 
posed to  believe  that  what  then  destroys  both  the  globules  of 
the  blood  and  the  fibrine,  is  something  which  is  no  longer  pus, 
but  the  ammoniacal  product  formed  at  the  expense  of  the  pus 
itself*  And  if,  as  can  hardly  be  doubted,  this  ammoniacal 
product  is  that  which  remains  upon  a  bistoury  that  has  been 
thrust  into  a  putrid  subject,  if  it  forms  the  basis  of  those  dele- 
terious emanations  which  escape  from  animal  bodies,  either 
dead,  or  in  dense  crowds  while  alive,  we  may  imderstand 
how,  in  these  cases  apparently  so  dissimilar,  the  blood  must 
undergo  alterations,  identical  in  their  nature,  and  variable 
only  in  degree ;  and  understand,  also,  how  symptoms  of  the 

•  The  excellent  thesis  lately  presented  to  the  Faculty  of  Medicine  by  M. 
D'Arcet  may  be  profitably  consulted  in  regard  to  this  subject. 

8* 


90  PATHOLOGICAL  HEMATOLOGY. 

same  order  should  result  from  causes  which  appear  so  dif- 
ferent. And  thus  it  is  that  inflammation,  the  essence  of  which 
is  to  make  the  blood  more  consistent,  by  increasing  its  fibrine, 
may  bring  about,  remotely,  the  liquefaction  of  the  blood  by 
the  destruction  of  its  fibrine.  This  is  what  happens,  if  the  pus 
created  by  the  inflammation  becomes  mingled  with  the  blood, 
after  undergoing  a  preliminary  alteration  and  decomposition 
within,  or  without,  the  place  where  it  was  formed.  But  the 
disease  has  then  changed  its  nature,  and  the  inflammatory  state 
is  replaced,  or  at  least,  overpowered,  by  the  typhoid  state ;  that 
is  to  say,  instead  of  there  being  more,  there  is  really  less 
fibrine  in  the  blood,  than  natural.  The  study  of  the  altera- 
tions of  the  blood  comes,  then,  to  confirm  one  of  the  most  im- 
portant principles  of  pathology,  namely,  that  in  proportion  as 
a  disease  passes  through  its  several  phases,  it  is  modified,  not 
only  in  its  symptoms,  but  in  its  essence.  Clinical  and  thera- 
peutic facts,  no  less  than  those  furnished  by  an  analysis  of  the 
blood,  do  not  permit  our  acceptance  of  the  dogma  maintained 
by  Tommasini,  that  a  disease,  commenced  with  one  diathesis, 
cannot  change  it  during  its  course ;  that  if  sthenic  in  the  begin- 
ning, it  will  remain  so  to  the  end,  and  that  consequently  its 
treatment  should  continue  to  be  uniform  from  beginning  to 
end. 

I  am  unwilling  to  leave  this  subject,  without  saying  a  few 
words  touching  the  influence  of  the  ordinary  antiphlogistic 
treatment  upon  the  blood. 

Amongst  the  various  forms  of  this  treatment  depletion  holds 
the  first  rank.  I  have  then  naturally  to  inquire,  how  far  bleed- 
ing, repeated  more  or  less  frequently,  has  the  power  of  re- 
moving the  excess  of  fibrine  in  the  blood,  rapidly  or  gradually. 
Now  it  is  found  that  however  repeated  or  abundant  the  bleed- 
ings, the  fibrine  increases  none  the  less,  if  these  bleedings  are 
performed  in  the  early  stages  of  an  inflammation  of  some  in- 
tensity, or,  in  other  words,  at  the  period  of  the  ordinary  m- 
crease  of  the  disease ;  on  the  other  hand  the  inflammation  does 
not  prevent  there  being  found,  after  each  bleeding,  a  progres- 
sive diminution  of  the  globules.    It  seems,  then,  that  when 


OP  THE  BLOOD  IN  DISEASES.  91 

once  the  blood  has  set  about  producing  an  excess  of  iibrine, 
no  matter  what  is  done,  a  certain  time  must  elapse  before  this 
disposition  is  exhausted.  Besides,  this  resistance  of  the  fibrine 
to  the  action  of  depletions,  and  the  development  it  acquires  in 
spite  of  them,  are  perfectly  in  keeping  with  what  takes  place 
in  the  inflamed  solid  itself,  and  in  the  rest  of  the  organism. 
The  most  copious  loss  of  blood  does  not  effect  the  immediate 
removal  of  the  lesions  of  the  solid ;  a  certain  space  of  time  is 
always  necessary  for  accomplishing  this,  and  for  the  extinction 
of  the  fever.  So  that  the  iibrine,  the  quantity  of  which  in  the 
blood  represents  the  degree  of  inflammation,  obeys  the  same 
law  wiiich  makes  the  latter  continue  for  a  certain  time,  and 
pass  through  certain  stages.  Let  it  not,  however,  be  thought 
that  I  deny  the  utility  of  blood-letting,  when  properly  em- 
ployed, in  this  class  of  diseases.  Experience  has  taught  me, 
that  without  removing  them  suddenly,  it  often  abridges  their 
duration,  and  conspires  to  bring  about  a  favourable  issue.  I 
even  admit  that  if  blood  be  drawn  at  the  very  outset  of  the 
inflammation,  while  yet  there  is  nothing  more  than  congestion 
in  the  solid,  and  the  fibrine  of  the  blood  hardly  above  its  nor- 
mal standard,  depletion  may  stop  the  progress  of  the  disease, 
and,  in  certain  cases  at  least,  render  it  really  abortive.  But  if 
the  disease  be  a  little  farther  advanced,  this  will  not  be  the 
case :  it  is  not  in  the  power  of  art  to  prevent  a  well  formed 
pneumonia  from  lasting  seven  or  eight  days  at  least,  although  it 
may  prevent  its  being  prolonged  for  a  fortnight.  You  cannot 
arrest  a  well  marked  case  of  acute  articular  rheumatism  within 
eight,  twelve,  and  oftener,  fifteen  or  twenty  days ;  but  by  the 
use  of  blood-letting  will  more  frequently  see  it  arrested  within 
the  last  named  period,  than  if  depletion  had  not  been  used.  I 
will  add  a  few  words  upon  the  modus  operandi  of  the  agents 
called  revulsives. 

I  do  not  deny  that  this  term  often  expresses  a  real  action,  by 
virtue  of  which  the  movement  they  attract  towards  the  skin, 
or  the  digestive  mucous  membrane,  may  put  an  end  to  that 
which  disease  has  developed  at  another  point :  1  even  believe 
that  one  or  more  fluxionary  movements  may  be  established 


92  PATHOLOGICAL  HEMATOLOGY. 

towards  these  membranes,  which  will  diminish  the  activity 
with  which  the  fluids  tend  to  the  part  originally  irritated  and 
congested.  But  another  influence  of  these  revulsive  agents, 
and  one  that  has  been  less  noticed,  is  that  which  they  may 
have  upon  the  composition  of  the  blood,  which  they  must 
modify  by  means  of  the  materials  which  they  extract  from  it. 
Thus  a  large  blister  takes  from  the  blood  a  certain  quantity  of 
its  serum  ;  but,  in  addition,  fibrine  is  deposited  upon  the  raw 
surface  produced  b)'-  the  action  of  the  cantharides.  If  the 
blood  should  contain  a  superabundance  of  fibrine,  would  that 
be  a  means  of  diminishing  its  excess  ?  Or,  on  the  contrary,  if 
the  blister  were  large  enough,  if  the  resulting  inflammation 
were  very  intense,  if,  above  all,  it  increased  the  already  exist- 
ing fever,  would  there  not  result  a  new  cause  for  the  forma- 
tion of  an  excess  of  fibrine  in  the  blood,  and  would  not  this 
cutaneous  inflammation,  thus  artificially  created  to  diminish 
the  intensity  of  another  inflammation,  and  by  the  sort  of  influ- 
ence it  would  have  on  the  blood,  augment  the  morbid  condi- 
tion which  represents  the  inflammatory  state  in  the  blood, 
and  is  the  measure  of  its  intensity  ?  As  to  purgatives,  which 
are  also  employed  as  revulsives,  it  may  be  asked  what  is  the 
nature  of  their  influence  on  the  blood,  according  to  whether 
they  chiefly  excite  the  flow  of  perspiration,  of  mucus,  or  of  bile, 
and  what  changes  of  composition  they  may  occasion  in  the 
blood.  This  is  undoubtedly  an  interesting  subject  for  investi- 
gation. 


ARTICLE  V. 

Of  the.  Blood  in  Hemorrhages. 

I  DO  not  intend,  in  this  article,  to  treat  of  the  influence 
which  profuse  losses  of  blood  may  have  upon  the  composition 
of  that  fluid ;  I  have  already  spoken  of  this  subject,  and  have 
stated  that  every  hemorrhage  certainly  lessens  the  quantity  of 
the  globules,  while,  on  the  other  hand,  it  must  be  very  pro- 


OF  THE  BLOOD  IN  DISEASES.  93 

longed  or  very  copious,  to  diminish  in  any  appreciable  degree 
the  amount  of  fibrine.  I  propose,  at  present,  to  inquire  how- 
far  all  hemorrhages  are  due,  originally,  to  some  modification 
of  the  composition  of  the  blood. 

From  the  examinations  I  have  made  of  this  subject,  I  be- 
lieve I  may  conclude  that  there  is  a  certain  number  of  hemor- 
rhages whose  cause  cannot  be  traced  to  any  primitive  lesion 
of  the  solids,  and  which  are  the  results  of  a  change  in  the 
composition  of  the  blood,  consisting  in  a  relative  or  absolute 
diminution  of  its  fibrine. 

And  let  us  remember,  at  the  outset,  that  the  ancients  ranked 
dissolution  of  the  blood  amongst  the  causes  of  hemorrhage. 
But  what  else  is  this  dissolution,  than  a  state  of  the  blood  in 
which  it  contains  less  fibrine  than  usual  ? 

Let  us  also  remember  that  hemorrhages  are  common  in 
diseases  where  the  blood  contains  but  little  fibrine,  such  as 
typhus  fever  and  scurvy ;  that,  on  the  other  hand,  they  are  rare 
in  diseases  where  there  is  an  excess  of  fibrine,  eitlier  positively, 
as  in  the  phlegmasias,*  or  relatively  as  in  chlorosis. 

In  the  diminution  of  the  fibrine  relatively  to  the  globules, 
we  must  recognize  the  grand  condition  of  the  blood  favourable 
to  the  production  of  hemorrhages ;  the  relation  of  these  two 
facts  is  so  constant,  that  it  seems  to  me  impossible  not  to  regard 
the  one  as  the  cause  of  the  other.  Let  it  not  be  said  that  the 
hemorrhage  induces  the  diminution  of  the  fibrine  in  the  blood; 
for,  as  I  have  already  stated,  the  loss  of  blood  must  be  very 
copious  to  produce  that  effect,  and  I  have  seen  the  fibrine  di- 
minish where  the  amount  of  the  hemorrhage  could  certainly 
not  explain  that  occurrence.  Finally,  I  may  add,  as  an  argu- 
ment that  appears  to  me  unanswerable,  that  if  the  hemorrhage 
produced  a  change  of  the  blood,  in  the  cases  under  considera- 
tion, the  globules  should,  unquestionably,  be  found  diminished 

*  It  may  be  objected  that  the  sputa  of  pneumonia  are  almost  always 
tinged  with  blood ;  but  I  reply  that  that  is  not  an  ordinary  hemorrhage.  The 
blood,  which,  in  this  disease,  is  mixed  with  the  expectorated  matter,  is  lite- 
rally the  result  of  its  forcible  expression  through  the  parietes  of  the  ultimate 
bronchial  ramifications. 


94  PATHOLOGICAL  HEMATOLOGY. 

in  a  larger  proportion,  even,  than  the  fibrine ;  but  this  is  not 
the  case,  and  so  far  from  it,  that  the  globules  are  most  fre- 
quently in  excess  relatively  to  the  fibrine. 

Two  very  different  conditions  of  the  blood,  in  which  the 
law  of  the  diminution  of  the  fibrine  relatively  to  the  globules 
persists,  may  predispose  to  hemorrhage. 

The  first  of  these  is  that  in  which  the  amount  of  globules 
has  reached  the  highest  limit  of  the  physiological  state,  or  has 
exceeded  it,  the  fibrine  meanwhile  preserving  its  normal  pro- 
portion, and  standing  at  least  as  often  below,  as  above,  its 
average.  This  is  what  takes  place  in  plethora,  and  common 
observation  teaches  us  that  plethoric  persons  are  disposed  to 
hemorrhage.  Who  is  not  familiar  with  their  frequent  epis- 
taxes,  and  with  the  relief  afforded  by  them  ?  This  is  because 
these  hemorrhages  infallibly  diminish  the  amount  of  globules 
of  the  blood,  without  affecting  its  fibrine ;  the  equilibrium  be- 
tween these  two  elements  is  thus  spontaneously  re-established 
in  these  persons,  and  hemorrhages  with  symptoms  of  plethora 
are  not  renewed  until  an  excess  of  globules  is  once  more  repro- 
duced along  with  the  blood. 

But  a  second  condition  of  the  blood  which  is  much  more 
favourable  than  the  preceding  to  the  production  of  repeated 
and  profuse  hemorrhages,  is  that  in  which  the  quantity  of 
fibrine  is  really  under  the  standard,  while  that  of  the  globules 
is  natural.     I  have  observed  this  in  scurvy. 

This  disease  resembles  chlorosis,  in  some  respects,  and  both 
have  symptoms  in  common.  In  both  may  be  remarked  the 
same  feebleness,  the  same  dizziness,  the  same  aberrations  of 
sensibility,  the  same  dyspnoja,  the  same  palpitations,  the  same 
dyspepsia.  But  that  which  distinguishes  scurvy  from  chlo- 
rosis is  the  readiness  with  which  hemorrhage  occurs  in  the 
former  affection,  so  as  to  constitute  one  of  its  characteristic 
symptoms.  And  why  do  hemorrhages  so  constantly  take 
place  in  scurvy,  so  rarely  in  chlorosis?  Because  in  the  former 
there  is  an  alteration  of  the  blood  quite  difierent  from  that  in 
the  latter.  In  sciuwy  the  globules  are  not  diminished  as  in 
chlorosis ;  on  the  contrary  the  fibrine  decreases  as  we  have 


OF  THE  BLOOD  IN  DISEASES.  95 

seen  it  do  in  typhoid  fever  of  an  adynamic  or  putrid  type ;  a 
disease,  which  not  less  from  its  symptoms,  than  from  the  alter- 
ations it  caused  in  the  blood,  had  been  very  correctly  styled 
acute  scurvy,  by  Borden. 

Well  marked  scorbutic  cases  are  so  rare  in  Paris,  that  for  a 
long  time  I  had  to  rest  contented  with  mere  conjecture  con- 
cerning the  state  of  the  blood  in  scm*vy,  and  had  admitted,  as 
very  probable,  that  it  must  contain  less  fibrine  than  natural. 
1  have  at  length  been  able,  by  observing  the  following  case,  to 
satisfy  myself  that  my  supposition  was  correct. 

In  the  course  of  April,  1841,  a  labourer,  forty-one  years  of 
age,  entered  my  wards  at  the  hospital  of  La  Charite.  For 
three  years  he  had  been  wearing  himself  out  by  the  daily  toil 
of  turning  a  crank  in  a  dark  and  wet  place,  leaning  against  a 
wall  from  which  the  moisture  was  incessantly  dripping.  About 
once  in  every  three  weeks  he  indulged  in  wine  to  intoxication. 
He  slept  with  seven  comrades  in  a  small,  badly-lighted,  and 
worse  ventilated,  chamber. 

At  the  commencement  of  March,  1841,  he  suffered  from 
vertigo,  and  a  contmual  weariness  that  he  could  not  account 
for ;  he  felt  sore  and  broken  down,  and  soon  was  attacked 
with  bleeding  at  the  nose,  which  recurred  every  morning.  A 
little  later,  red  spots  (as  he  called  them)  began  to  appear  all 
over  his  body ;  these  spots  became  more  numerous,  and  larger, 
and,  at  the  same  time,  his  feebleness  made  such  progress,  that 
he  was  obliged  to  quit  his  work. 

When  this  patient  came  under  my  notice,  his  trunk,  limbs, 
and  face,  were  covered  with  numerous  petechiae,  and  large 
ecchymoses,  which  might  have  been  mistaken  for  bruises ;  but 
so  far  from  there  being  such,  on  the  succeeding  days  we  saw 
others  like  them  forming  before  our  eyes.  The  gums  were 
soft,  swollen,  and  bleeding ;  the  epistaxes  continued,  but  spar- 
ingly. The  patient  complained  of  a  general  numbness,  a 
heaviness  of  the  head,  and  vertigo ;  he  begged  to  be  bled  to 
put  an  end  to  these  symptoms.  The  powers  of  digestion  were 
still  unchanged ;  there  were  some  palpitations  of  the  heart ; 
but  no  bruit  de  soxijp,t  in  the  carotids.     The  pulse  was  60, 


99  PATHOLOGICAL  HiEMATOLOGY. 

the  respiration.  20,  the  temperature  of  the  skin  in  the  axilla 
37.60.  The  great  predominance  of  cerebral  symptoms,  and 
the  idea  that  they  might  be  caused  by  a  sort  of  congestion, 
induced  me  to  have  the  patient  bled,  and  indeed  he  strongly 
desired  it.  I  found  in  the  blood,  globules  119;  solid  con- 
stituents of  the  serum  86  ;  and  fibrine  only  1.6. 

After  five  weeks  of  rest,  and  substantial  food,  and  under  all 
good  hygienic  influences,  this  man  regained  his  strength,  and 
the  symptoms  of  which  I  have  spoken  had,  at  least,  much  im- 
proved ;  yet  a  considerable  number  of  petechise  remained  upon 
his  skin,  and  his  gums  were  still  inclined  to  bleed.  In  this  con- 
dition he  went  out  on  the  18th  May. 

The  23d  May,  he  was  again  attacked  with  violent  vertigo ; 
his  appetite  was  lost;  he  had  a  profuse  epistaxis,  and  he 
returned  to  the  hospital  on  the  2d  of  June.  He  was  then  ex- 
tremely feeble ;  extensive  ecchymoses  covered  his  skin,  and 
the  conjunctivae  were  so  infiltrated  with  blood,  that  they  pro- 
truded beyond  the  cornea,  and  surrounded  it  like  a  pad:  the 
case  might  have  been  taken  for  one  of  double  chemosis.  Blood 
exuded  from  the  gums  and  mingled  with  the  expectorated 
mucus.  I  again  examined  the  blood ;  it  contained  the  same 
quantity  of  fibrine  as  at  first;  the  globules  had  fallen  to  111; 
the  solid  constituents  of  the  serum  remained  at  86,  of  which 
70  were  albumen,  and  9  of  other  organic  matters.  After  some 
time  the  patient  became  much  better,  and  went  out.* 

•  Nothing  is  more  difficult  than  the  complete  and  ultimate  cure  of  those 
diseases  in  which  the  blood  is  gradually  and  spontaneously  despoiled,  either  of 
its  globules  or  its  fibrine.  It  is  well  known  how  easily  chlorotic  girls  relapse, 
and  how  long  it  is  before  their  symptoms  disappear  entirely.  In  older  per- 
sons, who  become  anaemic  spontaneously,  the  reproduction  of  the  blood-glo- 
bules is  obtained  with  greater  difficulty.  As  regards  scurvy,  that  variety 
which  arises  under  the  influence  of  external  causes,  generally  yields  with  as 
much  ease,  as  soon  as  those  causes  cease  to  operate,  as  the  other  variety 
which  arises  spontaneously,  often  resists  every  means  that  may  be  brought 
against  it.  I  have,  it  is  true,  seen  some  scorbutic  patients  recover,  but  I  have 
seen  a  greater  number  whose  disease,  although  at  intervals  appearing  to 
improve,  never  totally  ceased,  and  sooner  or  later  became  so  aggravated  as 
to  induce  a  fatal  termination. 


OF  THE  BLOOD  IN  DISEASES.  97 

Here  then  is  a  disease,  in  some  sort,  of  the  same  type  with 
all  those  in  which  more  or  less  frequent  and  spontaneous  hemor- 
rhages arise  in  the  same  manner,  and  a  remarkable  alteration 
of  the  blood  accompanies  it,  to  wit,  a  diminution  of  fibrine.  I 
have  found  the  same  kind  of  alteration  of  the  blood  in  a  case  of 
scarlatina  which  terminated  fatally  on  the  second  day  of  the 
eruption.  In  this  case  there  were  petechias  all  over  the  skin, 
a  bloody  exsudation  within  the  mouth,  and,  at  the  autopsy,  I 
found  in  the  respiratory  apparatus  the  anatomical  signs  of  an 
extensive  pulmonary  apoplexy.  The  blood  contained,  fibrine 
2,  globules  133,  solid  constituents  of  the  serum  81,  of  which 
66  were  albumen,  and  6,  other  organic  substances.  I  do  not 
doubt  that  the  fibrine  of  the  blood  would  be  found  below  its 
normal  standard  in  all  distinct  cases  of  purpura  hemorrha- 
gica :  I  can  at  least  declare,  that  in  a  case  of  purpura  whose 
symptoms  resembled  those  of  the  severest  typhus,  I  found  the 
blood  in  that  state  of  fluidity  and  dissolution  which  is  the  ex- 
pression of  its  loss  of  fibrine. 

But  it  is  not  only  in  these  cases  of  repeated  hemorrhage,  or, 
if  the  term  be  preferred,  of  hemorrhagic  diathesis,  that  I  have 
seen  the  blood  thus  impoverished  in  fibrine.  I  have  elsewhere 
cited  cases  of  cerebral  hemorrhage,  where  also  the  attack  had 
been  preceded  by  a  diminution  of  the  fibrine  in  the  blood  ;* 
Hence,  whether  the  blood  escape  from  several  tissues  at  the 
same  time,  or  whether  it  find  exit  through  a  single  one  of 
them,  facts  lead  us  to  admit,  in  the  second  case  as  in  the  first, 
that  some  hemorrhages  take  place  because  the  blood,  deprived 
of  its  natural  proportion  of  fibrine,  has,  on  that  account,  lost  a 
portion  of  its  plasticity.  And  thus  we  are  led  to  find,  in  an 
alteration  of  the  blood,  the  starting  point  of  certain  morbid 
phenomena,  the  cause  of  which  is  usually  referred  to  a  lesion 
of  the  solids.  The  cases  in  which  the  fibrine  is  only  dimi- 
nished relatively  to  the  globules  in  excess,  belong,  by  virtue  of 
their  symptoms,  to  the  class  of  hemorrhages  called  active,  and 
the  cases  in  which  the  fibrine  is  really  diminished  belong  to 

•  First  Memoir  upon  the  alterations  of  the  blood,  &c. 
9 


98  PATHOLOGICAL  HEMATOLOGY. 

that  of  hemorrhages  called  passive.  A  somewhat  minute  in- 
vestigation of  the  alterations  of  the  blood  lends  a  new  support 
to  this  ancient  classification,  which  though  inadmissible  into 
certain  theories,  is  not  the  less  essential,  both  in  therapeutics, 
and  in  clinical  instruction.  In  spite  of  every  effort,  it  will 
never  be  possible  to  attribute  identity  of  cause  and  nature,  to 
the  hemorrhage  of  a  plethoric,  and  that  of  a  scorbutic  indi- 
vidual. 

I  have  abundantly  demonstrated,  that  the  most  usual  im- 
poverishment of  the  blood,  that  which  results  from  the  mere 
dimimition  of  the  globules,  is  not  a  direct  cause  of  hemor- 
rhage :  yet  it  happens,  from  time  to  time,  that  hemorrhage  is 
observed  to  come  on,  and  to  recur  with  disastrous  obstinacy, 
in  persons  who  have  suffered  from  excessive  loss  of  blood ; 
but  this  fluid  is  then  so  far  exhausted,  that  after  having  lost  a 
great  part  of  its  globules,  it  has  also  parted  with  much  of  its 
fibrine.  When  this  latter  condition  exists,  hemorrhages  may 
take  place  ;  so  that  their  occurrence  is  connected  with  the  last 
degree  of  impoverishment  of  the  blood,  not  because  the  globules 
are  then  greatly  diminished,  but  because  the  fibrine  has,  in  its 
turn,  given  way.  Besides,  when  blood  enough  is  taken  from 
an  animal  to  destroy  it,  and  this  blood  is  divided  into  several 
portions  for  separate  analysis,  the  fibrine  is  found  less  abun- 
dantly in  the  portions  last  drawn,  than  in  the  first.  Profuse 
hemorrhages  may,  then,  exhaust  the  blood  of  its  fibrine,  and 
this  explains  how  it  may  happen,  that  towards  the  end  of  a 
very  considerable  hemorrhage,  the  blood  may  escape  from 
other  outlets  than  those  from  which  it  at  first  issued.  I  re- 
member, for  instance,  having  seen  a  young  man  whose  whole 
cutaneous  surface  was  covered  with  petechige,  during  the  con- 
tinuance of  a  copious  epistaxis  which  could  not  be  arrested ; 
although,  until  that  time,  he  had  never  had  such  symptoms. 
These  facts  being  known,  we  can  conceive  how  a  hemorrhage, 
which  has  exhausted  the  system  by  its  copiousness,  and  by  its 
frequent  returns,  may  find  a  cause  of  persistence  and  relapse 
in  the  new  condition  of  the  blood  which  it  has  created.  Hence, 
one  of  the  dangers  resulting  from  large  depletion  resorted  to 


OF  THE  BLOOD  IN  DISEASES.  99 

for  the  arrestation  or  prevention  of  hemorrhages ;  it  may,  from 
its  excess,  have  the  effect  of  perpetuating  them  or  of  bringing . 
them  back. 

Hemorrhagic  blood,  as  regards  its  physical  properties,  does 
not  differ  from  that  of  the  pyrexiae.  It  never  presents  any 
buffy  coat,  without  inflammatory  complication.  The  clot  is 
generally  large,  and  never  small,  except  in  those  cases  of  ex- 
treme poverty  of  the  blood  of  which  1  spoke  last.  It  is  more 
commonly  remarkable  for  considerable  softness,  and  when  the 
hemorrhage  depends  on  a  very  great  diminution  of  fibrine,  the 
blood  may  be  so  little  coagulable  as  hardly  to  form  a  veritable 
clot ;  of  it  may  happen  that,  instead  of  this  latter,  there  is  no- 
thing in  the  vessel  containing  the  blood,  except  some  discon- 
nected lumps  suspended  in  reddish  serum.  This  is  that  state 
of  dissolutiou  of  the  blood  of  which  I  have  already  spoken 
under  the  head  of  the  pyrexiae,  and  which  exists,  more  or  less, 
in  all  the  diseases  characterized  by  a  general  disposition  to 
hemorrhage. 

I  have  already  had  occasion,  in  several  places  in  this  work, 
to  insist  upon  the  relation  which  may  be  shown  between  the 
dissolved  state  of  the  blood,  and  certain  morbid  phenomena  ; 
this  is  one  of  the  most  important  facts  in  medicine,  a  fact  very 
carefully  studied  by  the  observers  of  preceding  ages,  and  from 
which  the  exclusive  solidist  doctrines  of  our  day  had  entirely 
diverted  the  attention.*  I  have  shown  that  this  state  of  dis- 
solution of  the  blood  uniformly  coincided  with  a  diminution  of 
the  quantity  of  fibrine.  But  is  this  the  ultimate  alteration  we 
are  permitted  to  arrive  at  ?  Before  the  fibrine  decreases,  has 
there  not  been  some  other  change  of  composition  in  the  blood, 

•  Let  me  here  be  allowed  to  remind  my  readers,  that  in  a  work  published 
in  1823  {Clinique  Medicale,t.  I.)  I  had  admitted  and  described  this  state  of 
dissolution  of  the  blood  in  certain  cases  of  low  fever,  and  that  I  had  pointed 
it  out  as. capable  of  playing  a  part  in  the  production  of  several  of  the  symp- 
toms of  these  diseases,  and  especially  of  the  hemorrhages  which  so  often  ac- 
company them.  The  investigations  of  M.  Magendie  have,  more  recently, 
thrown  light  on  this  important  question  of  etiology.  (See  his  Lemons  sur  les 
phenomenes  physiques  de  la  vie,  1837.) 


100  PATHOLOGICAL  HiEMATOLOGY. 

of  which  the  depression  of  the  fibrine  below  its  normal  ave- 
rage is  itself  only  the  consequence  ?  Upon  this  subject  some 
facts  may  be  cited.  It  may  be  remembered  that  on  throwing 
into  the  veins  of  living  animals,  as  M.  Magendie  has  also  re- 
cently done,"^  a  concentrated  solution  of  subcarbonate  of  soda, 
an  almost  fluid  blood  was  found  in  the  bodies  of  these  ani- 
mals when  dead,  and  that,  during  life,  their  symptoms  were 
analogous  to  those  observed  in  diseases,  in  which  the  older 
writers  admitted  a  state  of  dissolution  of  the  blood.  It  may 
^Iso  be  remembered  that  some  authors  declare,  that  they  have 
found  an  excess  of  alkaline  matters  in  the  imperfectly  coagu- 
lated blood  of  persons  who  died  of  low  fevers  or  scurvy. 
I  may  also  state  that  in  the  investigations  which  I  am  now 
pursuing  in  regard  to  the  variations  in  the  proportions  of  the 
inorganic  constituents  of  the  blood,  I  have  found,  amongst 
other  things,  that  the  blood  most  highly  charged  with  free 
alkali  belonged  to  the  scorbutic  patient  whose  history  I  have, 
a  little  while  ago,  related.  This  is  a  result  analogous  to  that 
announced  by  M.  Fremy,  several  years  ago. 

The  different  virulent  and  miasmatic  substances  which,  on 
being  introduced  into  the  blood,  diminish  its  coagulability, 
may,  then,  act  upon  the  fibrine  like  the  alkaline  substances 
just  alluded  to.  Thus,  too,  the  venom  of  the  viper  may  act, 
which,  according  to  Fontana,  produces  a  dissolution  of  the 
blood. 

It  has  been  said  that  extreme  agitation  of  the  nervous  sys- 
tem may  deprive  the  blood  of  its  power  to  coagulate.  Accord- 
ing to  several  observers,  a  similar  effect  may  be  produced 
by  a  strong  moral  emotion,  a  concussion  of  the  brain,  the  de- 
struction of  a  certain  portion  of  the  spinal  marrow,  or  a  violent 
blow  upon  the  pit  of  the  stomach  affecting  the  nervous  plex- 
uses of  that  region.  If  facts  of  this  class  were  appropriately 
verified,  they  would,  doubtless,  be  of  the  highest  importance  : 
for  they  would  show  that  the  nervous  system  exerts  a  power- 
ful influence  on  the  constitution  of  the  blood,  and  that,  conse- 

•  Magendie,  t.  II,  p.  316. 


OF  THE  BLOOD  IN  DISEASES.  101 

qiiently,  a  lesion  of  innervation  may  deteriorate  the  blood,  just 
as  an  alteration  of  the  blood  may  modify  the  nervous  action. 
For  the  very  reason  that  such  facts  may  have  extensive  bear- 
ings, we  are  unwilling  to  receive  them  at  present,  and  we  wait 
until  new  facts  have  stamped  them  with  their  proper  value. 
Professor  Dupuy  of  Alfort  announced  that  by  dividing  the 
pneumogastric  nerves  in  horses,  the  blood  of  these  animals 
lost  its  property  of  coagulating.  But,  as  it  seems  to  be  the  fate 
of  our  science  that  it  shall  appropriate  no  truth  that  has  not 
been,  as  it  were,  purified,  by  the  test  of  contrary  facts,  the 
value  of  these  experiments  has  been  lessened  by  others  of  Dr. 
Mayer,  in  which,  this  savant,  having  tied  the  pneumogas- 
tric nerves  in  living  ailimg,ls,  found  that,  uniformly,  the  blood 
had  coagulated  throughout  the  whole  pulmonary  circulation. 
These  facts  require  |i  new  examination.  Nor  shall  we  receive, 
without  additional  proof,  certain  other  allegations,  already 
old,  from  which  it  would  result  that  the  blood  is  found  in  a 
state  of  dissolution  in  animals  killed  immediately  after  being 
violently  driven. 

Whatever  may  be  the  truth  regarding  the  number  and  the 
nature  of  the  causes  which  render  the  blood  less  coagulable,  it 
is  not  the  less  certain  that  there  are  some  diseases  in  which 
the  blood  shows  a  strong  tendency  to  dissolution,  while  there 
are  others  in  which  the  blood  becomes  more  coagulable.  A 
learned  Italian  physician,*  Bufalini,  even  regarded  these  two 
states  of  the  blood  of  such  importance,  as  to  make  use  of  them 
for  dividing  all  diseases  into  two  great  classes :  to  one  of  these 
he  assigns  as  cause  what  he  terms  the  phlogistic  process,  and 
to  the  other  an  opposite  state  of  the  system  which  he  desig- 
nates by  the  Xexm  process  of  dissolution  (processo  dissolutivo). 
This  division  is  equivalent  to  that  which  I  have  admitted,  into 
diseases  with  an  excess  of  fibrine  in  the  blood,  and  those  with 
less  than  the  normal  quantity  of  this  principle  ;  for  in  the  latter 
there  is  evidently  a  cause  whose  effect  is,  necessarily,  to  make 
the  blood  less  coagulable. 

•  Bufalini,  Fondamenti  di  patologia  analitka,  Pesaro  1830,  vol.  ii,  p.  327. 

9* 


102  PATHOLOGICAL  HEMATOLOGY. 

I  cannot  here  refrain  from  a  short  discussion  of  a  historical 
question,  long  ago  proposed  by  Grant.*  This  author,  who 
practised  medicine,  and  wrote  towards  the  close  of  the  last 
century,  suggested  the  inquiry  whether  the  peculiar  hygienic 
condition  of  the  people  of  Europe  before  the  eighteenth  cen- 
tury, must  not  have  caused  them  to  be  frequently  attacked 
with  diseases,  one  of  whose  principal  elements,  if  not  their 
starting  point,  was  a  state  of  dissolution  of  the  blood.  It  is 
certainly  very  remarkable  that  the  observers  of  preceding  ages, 
constantly  speak  of  dissolved  and  incoagulable  blood,  in  their 
histories  of  epidemics.  I  readily  admit  that  the  theories  then 
prevalent  may  have  contributed  to  make  this  state  of  the  blood 
appear  more  common  than  it  really. was.  I  know  very  well 
that  there  is  more  than  one  cause  of  error  to  be  avoided  in  this 
case  ;  that,  during  life,  blood  may  seem  less  disposed  to  coagu- 
late, merely  because  it  has  not  run  well  from  the  vein,  or  been 
received  in  a  proper  vessel,  I  also  know  that  blood  which 
has  coagulated,  as  usual,  soon  after  the  extinction  of  life,  will 
subsequently  become  fluid,  and  that  more  or  less  speedily  ac- 
cording to  the  temperature,  after  some  degree  of  putrefaction 
has  commenced  in  the  body ;  I  admit  that  these  circumstances, 
and  several  others,  may  have  been  overlooked  more  than 
once,  and  that  blood  has  been  regarded  as  dissolved  by  disease, 
when  it  was  so  only  from  some  accidental  cause.  Neverthe- 
less, all  the  circumstances  just  enumerated  were  as  well  known 
by  the  ancients,  as  by  ourselves ;  and  if  they  have  sometimes 
taken  no  account  of  them,  it  appears  to  me  difficult  to  suppose 
that  they  should  always  have  overlooked  them.  Besides,  in 
some  histories  of  epidemics,  they  are  very  careful  to  say  that 
the  blood  had  not  the  same  aspect  in  the  different  stages  of  the 
disease,  and  that,  for  example,  it  formed  a  distinct  clot  at  the 
commencement,  while,  at  a  later  period,  it  hardly  coagulated 
at  all.  This  record  of  the  changes  experienced  by  the  blood, 
in  proportion  to  the  progress  of  the  malady,  gives  a  great  value 
to  these  descriptions.     At  an  epoch  nearer  to  our  own  times, 

*  Grant,  Rtcherches  sur  ksfievres,  Lefebure's  translation,  vol.  I,  p.  276. 


OF  THE  BLOOD  IN  DISEASES.  103 

Sarcone,*  in  his  history  of  the  epidemic  of  Naples,  has  spoken 
of  the  difference  between  the  blood  drawn  at  the  commence- 
ment, and  tliat  drawn  towards  the  termination  of  the  disease. 

"  The  blood,"  says  this  author,  "was  tenacious  and  buffy 
during  the  first  week,  and  the  first  days  of  the  second ;  at  the 
end  of  the  second  week,  its  aspect  changed,  and  it  appeared 
to  be  more  distinctly  altered  ;  the  clot  could  be  easily  divided  ; 
a  slight  pressure  was  sufficient  to  break  it  up.  .  .  . ;  lastly,  these 
alterations  still  increased  in  the  course  of  the  third  week,  and 
especially  that  tendency  to  dissolution  which  appeared  at  the 
close  of  the  second  week.  The  blood,  drawn  from  a  vein, 
was  converted  into  a  thin,  black  coagulum,  swimming  in  a 
dirty  and  bloody  serosity."t 

The  disease  in  which  Sarcone  observed  this  alteration  of 
the  blood,  is  one  of  the  last  remnants  of  those  great  epidemics, 
which  continually  prevailed  in  Europe  during  the  middle  ages, 
and  whose  incessant  re-appearance  seemed  attributable  to  the 
bad  ventilation  and  food  peculiar  to  those  times.  In  those 
epidemics,  which,  indeed,  often  become  endemics,  nothing  was 
more  common  than  to  observe  gangrene,  hemorrhage  from 
various  parts,  extensive  ecchymoses,  or  thousands  of  petechiae 
covering  the  skin,  while  the  general  symptoms  of  our  typhoid 
fever  developed  themselves  with  a  high  degree  of  intensity, 
and  the  greatest  rapidity.  J  These  pyrexiee,  with  their  assem- 
blage of  dangerous  symptoms,  and  especially  their  hemorrha- 

*  Sarcone,  Systematic  account  of  the  diseases  observed  at  Naples  during^ 
the  year  1764,  translated  [into  French]  by  Bellay,  vol.  1. 

f  Huxham  (treatise  on  fevers)  has,  in  his  narrative  of  the  epidemic  fever 
of  Plymouth,  described  a  much  more  complete  dissolution  of  the  blood  than 
that  mentioned  by  Sarcone.  The  blood  of  the  patients,  seen  by  Huxham, 
did  not  even  present  a  distinct  coagulum;  the  vessel  appeared  to  contain 
nothing  but  a  brown  liquid,  at  the  bottom  of  which  was  deposited  a  sort  of 
reddish  powder,  formed  by  the  separate  particles  of  what  should  have  been 
the  clot. 

i  This  is  not  the  place  to  enter  into  detail  as  to  the  nature  of  the  hygienic 
influences,  which  even  at  a  period  not  very  far  distant,  gave  birth  to  and 
maintained  in  Europe  those  general  diseases  in  which  the  alteration  of  the 
blood  seems  to  play  so  important  a  part.    Even  men  unfamiliar  with  the 


104  PATHOLOGICAL  HjEMATOLOGT. 

gic  form,  rarely  appear  in  these  times,  and,  when  observed, 
only  as  sporadic  cases.  Scurvy,  as  an  endemic  disease,  has 
also  disappeared,  and  now  a  few  cases  of  it  only  are  seen.  This 
disease,  the  cases  of  which  were  formerly  so  numerous  in  Paris, 
can  hardly  be  said  to  exist  there  at  present,  except  by  the 
traces  it  has  left.  But  these  different  affections  are,  as  it  were, 
the  external  manifestation  of  the  internal  condition  of  the 
blood ;  we  must  therefore  admit,  that  in  consequence  of  the 
change  in  the  nature  of  the  influences  which  necessarily  act 
upon  men,  the  blood,  which  receives  before  the  solids,  the  im- 
pression of  the  greater  part  of  these  influences,  must  present 
changes  in  its  constitution  proportioned  to  those  undergone  by 
the  agents  which  operate  upon  it.  It  would  appear,  then, 
that  there  must  have  been  a  time  when  a  very  peculiar  consti- 
tution of  the  blood  engendered  maladies,  which,  in  certain 
respects,  may  have  differed  from  those  now  observed,  and 
may  not  have  required  the  same  treatment.  And  thus  it  is, 
that  at  different  periods  of  the  existence  of  our  race,  and 
through  the  diversity  of  influences  to  which  it  may  be  sub- 
jected, diseases  of  very  different  types  may  arise,  and  undergo 
changes  in  their  essential  nature  which  are  revealed  to  us  by 
the  specific  character  of  their  symptoms.  This  too,  is  one 
amongst  many  reasons,  why,  according  to  the  times,  some 
theories  may  be  received  with  peculiar  favour,  and  explains 

practice  of  medi(^e  were,  themselves,  struck  by  it.  Erasmus,  the  philoso- 
pher, who  flourished  towards  the  close  of  the  sixteenth  century,  wrote 
that,  in  his  day,  the  inhabitants  of  London  were  every  year,  from  spring 
to  harvest,  attacked  by  a  malignant  fever,  which  committed  the  greatest 
ravages  in  that  city,  and  especially  amongst  the  poorer  classes.  I  have 
been  struck  with  the  following  details  given  by  Erasmus  of  the  causes  to 
which  he  attributes  this  fever.  "  The  supply  of  water,"  he  says,  "  fails  the 
inhabitants ;  they  have  to  seek  it  at  a  great  distance  from  the  city ;  the  river 
water  is  carried  upon  their  backs,  and  is  so  dear  that  the  poor  cannot  pro- 
cure enough  of  it  to  wash  themselves,  and  keep  their  houses  clean.  These 
houses  are  of  wood,  and  very  cold  in  winter,  which  makes  it  necessary  to  fill 
the  rooms  with  straw.  But  as  this  cannot  be  often  renewed,  it  becomes 
spoiled,  and  very  injurious."  I  find  this  passage  in  Grant,  who  quotes  it, 
(vol.  i,  p.  288,  op.  cit.) 


OF  THE  BLOOD  IN  DISEASES.  105 

how  the  development  of  these  theories  may  be  favoured  by 
the  very  nature  of  the  facts  observed. 

The  dissoUition  of  the  blood  has  been  regarded,  at  other 
epochs  of  our  science,  as  connected  witli  another  state,  which 
was  held  to  be  very  common  during  the  empire  of  the  old 
humoral  doctrines,  I  mean  piciric/iiy;  and  as,  in  our  day,  this 
term  has  been  revived  by  some  persons,  it  is  well  to  ascertain 
its  meaning. 

As  long  as  the  blood  circulates  in  the  living  vessels,  it  is  in- 
admissible to  suppose  that  it  can  undergo  a  real  putrefaction. 
Yet  there  is  a  certain  number  of  diseases  in  which,  after  death, 
every  part  of  the  body,  but  especially  the  blood,  much  more 
speedily  presents  the  signs  of  putrefaction,  than  in  others,  and 
these  diseases  are  precisely  those  in  which  the  blood  has  lost 
its  coagulability  during  life.     Independently  of  this  common 
character,  they  have  all  a%)eculiar  aspect ;  their  ordinary  phe- 
nomena being  rapid  prostration,  fostor  of  the  excretions,  and 
a  tendency  to  hemorrhage,  and  gangrene.     These  the  ancients 
considered  as  signs  of  the  putrid  state ;  but  they  are  nothing 
more  than  signs  of  the  diseases  in  which  the  spontaneously 
coagulable  matter  of  the  blood  is  more  or  less  diminished. 
The  rapidity  with  which  putrefaction  after  death  is  observed 
to  take  place,  in  these  cases,  simply  depends,  perhaps,  on  the 
tissues  being  more  promptly  impregnated  with  blood,  on  ac- 
count of  its  fluidity,  which  allows  it  to  transude  through  the 
coats  of  the  vessels  very  soon  after  the  cessation  of  life.     Let 
us  also  remark  that,  in  the  language  of  Boerhaave  and  Hux- 
ham,  the  phrases  dissolved  state  and  putrid  state  were  sy- 
nonymous.    So  that,  in  their  numerous  treatises  upon  diseases 
which  they  called  putrid,  the  older  writers  have   done  no 
more  than  transmit  to  us  their  observations  and  their  hypo- 
theses touching  that  extensive  class  of  maladies,  in  v/hich  the 
blood  docs  not  contain  its  normal  quantity  of  fibrine,*  and 

*  Schwenck  thus  describes  the  qualities  of  the  blood  in  putrid  diseases: 
"  In  morbis  putridis,  dissolutio  cruoris  advertitur,  et  a  vena  emissus  sanguis 
non  coagulatur."  (Schwenck,  Haematologia,  p.  129.) 


106  ,      PATHOLOGICAL  H^MATOLOGT. 

these,  moreover,  they  set  in  opposition  to  inflammatory  dis- 
eases, just  as  om'  modern  investigations  authorize  us  still 
to  do. 

Long  before  Schwenck,  Fernel  had  also  noticed  the  absence  of  coagula- 
tion in  the  blood  as  one  of  the  fundamental  characters  of  putrid  diseases. 
Upon  this  subject  he  expresses  himself  thus : 

"Sanguis,  qui  per  febres  putridas  detrahitur,  seepe  animadvertitur  putri- 
dus,  adeo  ut  nee  sibi  coheerere,  nee  concrescere  queat,  omnibus  scilicet  ejus 
fibris  putredineconsumptis."  (Fernel,  De  febribus,  cap.  v.) 

In  a  very  remarkable  work  of  Huxham,  entitled  "An  essay  on  fevers,  and 
on  the  different  kinds  of  fevers  which  depend  on  the  constitution  of  the  blood" 
there  is  a  chapter  whose  title  is,  "  On  the  dissolved  and  putrid  state  of  the 
blood,"  and  there  Huxham  has  recorded  a  very  interesting  case,  which  ap- 
pears to  me  eminently  fitted  to  show  the  identity  of  nature  of  those  diseases 
formerly  called  putrid,  and  those  in  which  the  blood  has  been  proved,  by 
analysis,  to  be  spontaneously  deprived  of  a  certain  quantity  of  its  fibrine. 

The  subject  of  this  case  was  a  surgeon,  who  in  October  1741  was  seized, 
without  known  cause,  with  alternate  rigors  md  flushes  of  heat,  a  weak  pulse, 
loss  of  strength  and  appetite ;  and  heavy  respiration ;  he  continued  at  his 
business  in  spite  of  the  fatigue  he  experienced.  Four  or  five  days  after  his 
seizure,  Huxham  met  him  at  a  patient's  house,  and  observed  that  his  breath 
was  foetid.  Two  days  after,  he  being  at  another  patient's  house,  suddenly 
fainted.  When  he  came  to  himself  several  livid  and  violet-coloured  spots 
were  observed  on  his  hands  and  neck.  On  the  way  home,  he  fainted  several 
times.  The  disorder  increased  every  moment;  he  had  extreme  languor,  and 
great  oppression,  with  continual  sighing;  his  breath  was  now  insupportably 
foetid,  blood  leaked  from  his  gums,  and  a  great  many  livid,  violet,  and  black 
spots  appeared  all  over  his  body,  on  the  trunk,  as  well  as  the  limbs. 

Huxham  continues  the  narrative  as  follows: 

"He  was  bled  to  about  3xii  from  his  arm,  but  this  gave  him  no  manner  of 
relief,  the  oppression,  sighing,  fainting,  and  anxiety  continuing  as  bad  as 
ever,  nay  rather  increasing; — a  violent  hemorrhage  also  broke  forth  from  his 
nose;  which  continuing  from  both  nostrils,  he  was  bled  again  to  3x  about 
twelve  hours  after  the  fornaer  bleeding: — neither  did  this  give  him  any  relief, 
but  increased  his  weakness  considerably,  and  he  continued  as  anxious,  rest- 
less, and  oppressed  as  ever,  without  even  the  least  sleep.    The  blood  now 

not  only  issued  from  his  gums  and  nose,  but in  a  surprising  manner 

likewise  dropped,  though  slowly,  from  the  caruncle  of  one  of  his  eyes ;  and 
several  livid  pustules  on  his  tongue,  and  within  side  his  lips,  broke,  and  dis- 
charged a  bloody,  thin  matter  very  copiously. 

"The  hemorrhage  being  somewhat  restrained,  a  bloody  dysentery  came  on 
with  severe  gripes,  and  excessive  faintness,  and  he  was  still  exceeding  rest- 
less and  very  feverish:  his  pulse  now  intermitted  every  sixth  or  eighth  pul- 


OF  THE  BLOOD  IN  DISEASES.  107 

ARTICLE  VI. 
0/  the  Blood  iji  Dropsies. 

It  is  at  present,  generally  acknowledged  that,  while  some 
forms  of  dropsy  depend  upon  certain  alterations  of  the  solids, 
there  are  others  again  whose  point  of  departure  must  be  sought 
for  in  an  alteration  of  the  blood.  It  has  been  asserted  also  in 
rather  a  vague  way  that  serous  effusions  might  be  the  conse- 
quence of  an  impoverishment  of  the  blood,  or  of  what  has 
been  called  hydroa^mia.  This  opinion,  I  am  now  about  to 
examine. 

And  in  the  first  place,  we  may  understand  by  the  expres- 
sion, impoverishment  of  the  blood,  very  different  conditions  of 
that  fluid.  The  blood  may  really  have  lost  somewhat  of  its 
accustomed  richness,  from  its  containing  either  less  fibrine, 
fewer  globules,  or  less  albumen  than  usual.     In  these  three 

sation,  and  then  fluttered  on  again  vastly  quick;  he  had  likewise  a  constant 
tremor  and  subsultus.  The  hemorrhage  all  this  while  continued  from  one 
part  or  other,  and  when  stopped  at  one  place  forthwith  burst  out  at  another; 
so  that  his  urine  now  seemed  tinged  with  blood.  . . .  Soon  after  he  was  bled 
the  second  time,  I  was  sent  for,  and  hastened  to  him.  I  found  him  in  the 
manner  described,  under  an  inexpressible  anxiety,  )'-et  quite  free  from  a  de- 
lirium, though  he  had  no  manner  of  sleep  for  several  days  and  nights:  his 
tongue  was  vastly  black,  and  his  breath  and  stools  insufferably  stinking. 

"I  found  that  neither  of  the  portions  of  the  blood  that  had  been  drawn  (not 
even  the  first)  had  separated  into  crassamentum  and  serum  as  usual,  though 
the  former  had  stood  so  many  hours ;  but  continued  as  it  were  half  coagu- 
lated, and  of  a  bluish  livid  colour  on  the  top: — it  was  most  easily  divided  by 
the  slightest  touch,  and  seemed  a  purulent  sanies  rather  than  blood,  with  a 
kind  of  sooty  powder  at  bottom.  His  hemorrhage  still  continued,  especially 
from  the  tongue,  lips,  and  gums,  with  a  perpetual  dripping  of  bloody  ichor 
from  the  nose;  with  never  ceasing  tremblings,  subsultus  tendinum,  and  al- 
most continual  faintings." — [An  Essay  on  fevers,  &c.,  by  John  Iluxham, 
M.D.,  3d  edition,  London,  1757.] 

Huxham  put  this  patient  on  the  use  of  small  and  repeated  doses  of  Peruvian 
bark,  and  various  aromatic  and  astringent  substances ;  he  endeavoured  to 
nourish  him  moderately,  and  succeeded  in  gradually  restoring  him  to  health. 


108  PATHOLOGICAL  HEMATOLOGY. 

cases,  it  should  be  equally  regarded  as  impoverished;  do  they 
all  then  give  rise  to  dropsy  ? 

Diminution  of  the  fibrine,  to  whatever  extent  it  may 
have  gone,  does  not  certainly  produce,  as  one  of  its  conse- 
quences, the  formation  of  this  disease.  In  those  morbid  con- 
ditions in  which  the  blood  has  lost  no  other  principles  than  its 
spontaneously  coagulable  matter,  we  do  not  see  effusions  into 
the  areolae  of  the  cellular  tissue,  any  more  than  into  the  serous 
membranes,  occur  as  an  ordinary  phenomenon.  If  these 
effusions  are  produced  in  that  condition,  it  is  the  exception ; 
and  it  becomes  necessary,  consequently,  to  seek  some  other 
cause  for  them  than  the  diminution  of  the  cipher  of  the 
fibrine. 

Is  the  diminution  of  the  globules,  which,  however  slight, 
brings  with  it  as  a  necessary  result,  the  hydrosemic  condition, 
a  cause  of  the  production  of  dropsy  any  more  than  the  pre- 
ceding ?  It  is  generally  thought  to  be,  and  yet  it  seems  to  me 
that  a  somewhat  rigorous  observation  does  not  permit  us  to 
adopt  this  opinion. 

Were  it  true  that  dropsy  was  the  ordinary  consequence  of  a 
diminution  of  the  globules  of  the  blood,  it  ought  to  follow  from 
this  that  the  greater  number  of  chlorotic  patients,  especially 
those  who  have  the  disease  in  a  marked  manner,  should 
sooner  or  later  become  dropsical.  But,  this  certainly  is  not 
the  case.  I  have  never  seen  the  serous  cavities  filled  with 
fluid  in  cases  of  simple  chlorosis,  nor  have  I  ever  observed  a 
true  anasarca ;  at  most  we  may  find  in  some  chlorotic  patients 
slight  osdema  around  the  malleoli,  or  slight  puffiness  of  the 
eyelids,  and  that  is  all ! 

Neither  have  I  observed  dropsy  to  occur  in  men  attacked 
with  spontaneous  anaemia,  who,  like  chlorotic  girls,  had  but  a 
very  feeble  proportion  of  globules  in  their  blood.  I  have  said 
elsewhere  that  there  is  a  kind  of  cachexia  produced  by  the 
prolonged  operation  of  saturnine  emanations,  a  cachexia  also 
characterized  by  a  great  diminution  of  the  globules  of  the 
blood.  I  have  treated  many  patients  of  this  kind  at  La  Cha- 
rite,  and  have  never  observed  dropsy  in  any  of  them. 


OF  THE  BLOOD  IN  DISEASES.  109 

'■  Phthisical  persons,  in  whom  there  generally  exists  a  rather 
low  cipher  of  globules,  do  not  become  dropsical,  unless  the 
pulmonary  tubercles  coincide  with  some  other  affection,  whose 
effect  is  to  give  rise  to  serous  effusions,  as  for  example,  disease 
of  the  heart,  liver,  or  kidneys. 

With  the  exception  of  chlorosis,  I  have  rarely  seen  the  glo- 
bules descend  to  so  low  a  cipher,  and  the  anaemia  become  so 
marked  as  in  individuals  exhausted  by  some  chronic  organic 
disease  of  the  stomach.  In  such  cases  there  existed,  in  conse- 
quence of  this  considerable  diminution  of  the  globules,  a  well 
marked  hydroaemia,  and  yet  they  presented  me  no  trace  of 
dropsy.  In  women  labouring  under  cancer  of  the  uterus,  the 
blood  comes  insensibly  to  contain  but  very  few  globules,  in 
consequence  of  the  hemorrhages  which  many  of  these  persons 
suffer  from  almost  constantly ;  yet,  we  do  not  find  dropsy  super- 
vening in  these  cases,  any  more  than  in  the  preceding;  there 
was,  for  example,  no  trace  of  it  in  one  of  these  women,  whose 
case  I  have  elsewhere  cited,  and  whose  blood  contained  only 
21  in  globules.* 

Here  then  are  many  different  cases  in  which,  however  im- 
poverished the  blood  may  have  become  in  consequence  of  the 

•  I  am  not  ignorant  of  the  fact  that,  in  some  women  who  have  cancer  of 
the  uterus,  we  find  not  unfrequently  oedema  of  the  lower  extremities,  or  serous 
effusion  into  the  abdomen;  some  have  anasarca  even.  But,  on  the  one 
hand,  these  various  dropsies  are  not  in  such  cases  in  proportion  to  the  abun- 
dance or  frequency  of  the  uterine  hemorrhages ;  and  on  the  other  hand, 
whenever  I  have  met  with  them,  I  have  been  able  to  account  for  their  pre- 
sence by  the  existence  of  different  alterations  of  the  solids.  Thus  the  oedema 
of  the  lower  extremities  was  'explained  to  me  by  tumours  developed  in  the 
pelvic  excavation,  which  compressed  the  crural  veins,  or  by  coagula  formed 
•in  those  veins  during  life.  Cancerous  masses,  deposited  in  front  of  the 
vertebral  column,  a  disease  of  the  liver,  a  chronic  peritonitis,  tumours  ob- 
structing the  circulation  in  the  superior  vena  cava,  or  in  the  axillary  veins, 
accounted  to  me  for  the  occurrence  whether  of  ascites,  or  of  serous  infiltration 
into  one  or  both  of  the  superior  extremities.  In  the  same  way  when  cancer 
of  the  stomach  is  accompanied  by  ascites,  we  may  affirm  that  the  disease  is 
not  simple ;  and,  if  cancerous  tumours  do  not  exist  in  the  peritoneum,  we 
may  be  almost  certain  that  the  liver  has  participated  in  the  degeneration  of 
the  stomach. 
10 


110  PATHOLOGICAL  HEMATOLOGY. 

diminution  of  its  globules,  dropsy  does  not  result.  But,  in 
all  these  cases,  the  blood  has  been  slowly  and  gradually  de- 
prived of  its  globules.  I  have  now  to  examine  another  con- 
dition, that  in  which  the  diminution  of  the  globules  has  oc- 
curred rapidly  and  almost  instantaneously:  thus  it  happens 
in  persons  who  lose  suddenly  a  very  large  quantity  of  blood. 
Do  we  see  dropsy  estabhsh  itself  more  readily  in  such  a  case? 
I  do  not  fear  to  affirm  that,  even  in  this  case,  serous  effusions 
occur  only  as  an  exceptional  condition ;  they  are  observed 
much  less  frequently  than  has  been  asserted  after  even  very 
abundant  bleedings ;  let  us  remark  however  that  this  cause 
produces  them  somewhat  less  rarely  in  children  than  in  adults 
Neither  do  excessive  spontaneous  hemorrhages  necessarily 
give  rise  to  dropsies :  I  will  cite  as  proof  of  this  the  case  of  a 
young  woman  who,  a  few  days  before  her  entrance  into  La 
Charite,  and  in  good  health  up  to  that  time,  had  had,  in  conse- 
quence of  an  abortion,  a  metrorrhagia  so  profuse  that  she 
resembled  when  I  saw  her,  a  chlorotic  person  in  the  most 
advanced  stage ;  a  very  strong  bruit  de  souffle  could  be  heard 
in  the  heart  and  two  carotids.  This  woman  was  so  feeble 
and  exhausted  that  it  seemed  as  though  she  would  expire  in 
some  of  the  continual  syncopes  which  she  fell  into.  During 
the  following  days,  her  strength  improved  somewhat;  she 
retained  however  the  paleness  of  death,  and  could  not  as  yet 
make  a  movement  without  being  threatened  with  fainting.  It 
was  necessary  for  two  months  to  elapse  before  she  could  begin 
to  leave  her  bed,  and  yet  at  the  end  of  this  time  she  still  re- 
tained a  bruit  de  souffle  in  the  heart  and  carotids.  During 
these  two  months,  and  afterwards,  I  sought  with  care  for  the 
slightest  traces  of  dropsy  in  her  case,  but  discerned  none ;  the 
pressure  of  the  finger  produced  not  the  slightest  mark  upon 
the  malleoli.  She  had  merely,  as  some  chlorotic  patients  have, 
a  slight  swelling  of  the  face,  which  is  not  oedema,  for  the  skin 
in  such  conditions  does  not  retain  the  impression  of  the  finger. 
I  have  seen  so  many  cases  like  the  preceding  that  I  do  not 
hesitate  to  assert  that  dropsy  does  not  generally  result,  when 
the  impoverishment  of  the  blood  depends  simply  upon  the 


OF  THE  BLOOD  IN  DISEASES.  Ill 

diminution  of  its  globules.  Consequently,  when  it  does  occur, 
we  should  reasonably  infer  that  the  blood  must,  at  the  same 
time  that  it  has  lost  some  of  its  globules,  have  become  im- 
poverished in  some  other  mode ;  and  as  it  is  not  the  diminu- 
tion of  its  fibrine  which  can  bring  on  this  result,  we  may  ask 
ourselves  whether  it  be  not  owing  to  a  diminution  that  shall 
have  taken  place  in  the  albumen  of  the  serum.  Let  us  see 
what  facts  will  reveal  to  us  on  this  point. 

There  is  a  disease  which,  at  the  same  time  that  it  adds  to 
the  ordinary  prhiciples  of  the  urine  a  certain  amount  of  albu- 
men, lessens  more  decidedly  than  any  other  the  cipher  of  the 
albumen  of  the  blood.  Now,  in  this  disease,  which  has  the 
kidney  for  its  seat,  one  constant  phenomenon  appears  sooner 
or  later ;  this  is  dropsy,  which,  at  first  partial  and  slight,  ends 
by  becoming  general  and  very  considerable.  This  dropsy 
augments  in  proportion  as  there  escapes  from  the  kidneys  a 
larger  quantity  of  albumen,  and  as  we  find  less  of  it  in  the 
blood.  Hence  there  are  three  facts  which  co-exist,  disease  of 
the  renal  parenchyma,  diminution  of  albumen  in  the  blood 
and  dropsy.  Is  it  the  disease  of  the  kidneys  which  produces 
the  dropsy  directly,  as  does  an  affection  of  the  heart  or  liver  ? 
This  cannot  be  admitted,  for  it  is  manifest  that  the  kidneys 
exercise  an  influence  upon  the  formation  of  the  dropsy  but 
indirectly,  and  in  so  much  only  as  the  change  that  has  occurred 
in  its  texture  allows  it  carry  off  from  the  blood  its  albumen. 
It  is  then  the  diminution  of  this  latter,  in  the  serum  of  the  blood, 
which  must  be  regarded  as  the  true  cause  of  the  dropsy. 
Whatever  then  be  the  cause  which  makes  this  albumen  di- 
minish, dropsy  will  result.  And  moreover,  it  is  not  necessary, 
in  order  that  this  effect  be  produced,  for  the  globules  to  di- 
minish at  the  same  time  with  the  albumen.  In  Eright's  dis- 
ease, there  is  at  first  diminution  of  the  cipher  of  the  albumen 
alone,  and  the  globules  do  not  begin  to  decrease  until  later, 
when  dropsy  already  exists. 

Diminution  of  the  albumen  of  the  blood  has,  up  to  the  pre 
sent  period,  been  met  with  in  man  only  in  cases  where  this 
fluid  has  first  lost  a  portion  of  its  albumen  through  the  kidneys 


112  PATHOLOGICAL  HEMATOLOGY. 

I  have  shown  in  another  work,*  that,  in  animals  of  the  sheep 
kind,  the  diminution  of  albumen  may  occur,  independently  of 
the  preliminary  discharge  of  this  principle  by  the  urine  ;  serous 
infiltrations  also  result  from  it  occasionally  in  these  animals, 
which  helps  to  prove  that  their  production  is  not  in  imme- 
diate dependence  upon  the  disease  of  the  renal  parenchyma ; 
but  sheep  in  this  case   always  have  entozoa  in  the  biliary 
duct.     Is  this  then,  a  cause  of  the  loss  of  albumen  from  the 
blood  of  those  animals  ?     We  do  not  then  as  yet  possess  any 
well  established  case  proving  that  the  albumen,  like  the  glo- 
bules and  fibrine,  may  spontaneously  diminish  in  the  blood,  to 
an  extent  sufficient  to  produce  disease.     Nevertheless  we  have 
a  right  to  affirm  that  there  is  but  one  kind  of  change  of  com- 
position of  the  blood  which  results  necessarily  in  the  produc- 
tion of  dropsy,  and  this  alteration  is  the  diminution  of  the 
albumen ;  consequently,  whenever  we  see  dropsy  arise  from 
what  we  suppose  to  be  some  modification  experienced  by  the 
blood,  W3  ought  naturally  to  seek  whether  this  fluid  has  not 
lost  a  portion  of  its  albumen.     Besides,  it  is  not  only  from  an 
excess  of  watery  particles  in  the  blood,  that  serous  effusions 
are  formed  •,  for,  if  this  were  true,  as  I  have  before  said,  every 
chlorotic  person  should  become  dropsical,  whereas,  we  see 
dropsy  on  the  contrary,  depending  on  another  kind  of  altera- 
tion of  composition  of  the  blood,  one  in  which  it  does  not  con- 
tain a  great  superabundance  of  water. 

The  dropsy  which  occurs  towards  the  end  of  certain  cases 
of  scarlatina,  seems  to  me  equally  to  recognize  as  exciting 
cause  a  diminution  of  the  albumen  of  the  blood;  for  in  this 
species  of  dropsy  I  have  always  found  that  the  urine  had  be- 
come albuminous. 

We  sometimes  see  individuals  Avho,  having  been  exposed 
to  some  sudden  cause  of  cold,  are  attacked  a  few  hours  after 
with  anasarca.  This  accident,  somewhat  rare  in  our  climates, 
is  common  on  the  contrary  in  equatorial  regions.     Upon  what 

*  Memoire  sur  la  composition  du  sang  chez  quelques  animaux  domes- 
tiques. 


OF  THE  BLOOD  IN  DISEASES.  113 

depends  this  kind  of  dropsy  ?  I  long  accounted  for  it  by  sup- 
posing tliat  the  sudden  suppression  of  the  cutaneous  function 
of  transpiration  rapidly  produced  a  superabundant  exhalation 
of  serum  into  the  areolae  of  the  cellular  tissue  and  the  serous 
cavities.  But  a  fact  that  I  have  recently  observed  permits  me 
to  explain  otherwise  the  formation  of  this  kind  of  dropsy. 
This  fact  is  the  following : 

A  young  man,  previously  in  good  health  and  strongly  con- 
stituted, enters  the  hospital  of  La  Charite  with  considerable 
anasarca  and  commencing  ascites.  He  relates  to  me  that,  a 
few  days  before,  being  abed  and  asleep,  some  of  his  comrades 
poured  upon  him  a  pot  of  cold  urine,  while  he  was  in  a  state 
of  perspiration.  He  got  up  naked  in  order  to  pursue  them, 
and  was  very  much  chilled ;  he  remained,  said  he,  as  though 
frozen.  From  the  day  following  this  occurrence,  he  began  to 
perceive  a  slight  degree  of  swelling,  which  rapidly  augmented. 
I  examined  the  urine  of  this  patient,  and  found  it  albuminous. 
I  concluded  from  this  that  the  blood  had  been  deprived  by  the 
kidneys  of  a  certain  amount  of  its  albumen,  and  in  this  way 
accounted  to  myself  for  the  formation  of  the  dropsy.  It  is  then 
upon  the  kidneys  that  the  action  of  the  cold  had  fallen.  This 
dropsy  was  not,  moreover,  of  long  duration ;  at  the  end  of  a 
fortnight,  the  cure  was  complete. 

Cases  of  dropsy  following  insufficient  alimentation  have  been 
cited,  and  Dr.  Gaspard  has  even  reported  a  true  epidemic  of 
this  kind,  that  prevailed  in  1816,  through  several  departments 
of  the  interior  of  France,  as  the  result  of  a  great  scarcity  which 
had  afflicted  those  districts.*  The  inhabitants  had  been  re- 
duced to  seek  their  food  among  the  roots  and  herbs  of  the 
fields,  which  they  cooked,  etc.  A  large  number  of  them  be- 
came dropsical.  History  informs  us  that  the  same  thing  has 
occurred  at  other  epochs  under  the  influence  of  the  same  cir- 
cumstances. It  is  probable  that,  in  these  singular  epidemics, 
the  insufficiency  of  alimentation  must  have  modified  the  com- 
position of  the  blood ;  that  there  was  the  point  of  departure  of 

•  Journal  de  Physiologie  experimentale,  par  31.  Magendie,  tome  ii. 

10* 


114  PATHOLOGICAL  HEMATOLOGY, 

the  dropsy,  and,  after  what  I  have  said  m  the  preceding  pages, 
it  is  allowable  to  conjecture  that  the  blood,  under  the  empire 
of  this  influence,  experiences  a  diminution  of  its  albumen. 
What  may  still  add  some  weight  to  this  conjecture,  is  what 
takes  place  in  sheep,  when  they  have  fed,  for  some  time,  in 
humid  places,  in  pasturage  of  quality  insufficient  to  furnish  a 
good  reparative  material  for  their  blood ;  in  them  also,  the 
blood  loses  a  portion  of  its  albumen,  and  they  become  drop- 
sical. 

I  shall  not  seek  to  discuss  the  question  why  blood,  which 
has  become  poor  in  albumen,  brings  on  readily  the  formation 
of  serous  effusions,  and  wherefore  diminution  of  globules  in  the 
same  blood  does  not  produce  a  similar  result.  Is  it  the  change 
effected  in  the  physical  qualities  of  the  serum,  by  the  loss  of 
albumen  which  assists  the  passage  of  the  former  through  the 
vascular  parietes  ?  Is  this  then  a  case  of  exosmosis  favoured  by 
the  diminution  in  density  of  the  fluid,  or  is  it  that  the  water  of 
the  blood  flows  with  more  difficulty  in  the  capillary  rete,  be- 
cause, being  less  charged  with  fibrine,  it  has  become  less  unc- 
tuous, and  shdes  perhaps  less  readily  over  the  internal  surface 
of  the  vessels?  If  it  be  so,  the  diminution  of  albumen  in  the 
serum  of  the  blood  would,  as  one  of  its  effects,  render  more  diffi- 
cult the  passage  of  this  ffuid  through  the  small  vessels,  and  con- 
sequently as  to  the  immediate  cause,  there  would  not  be  so  great 
a  difference  between  dropsy  following  an  organic  disease  of 
the  heart  or  liver,  and  that  which  follows  the  diminished  pro- 
portion of  albumen  in  the  blood. 

Let  no  one  believe  however  that,  in  cases  of  dropsy,  there 
occurs  only  a  separation  of  serum  such  as  it  existed  in  the 
blood ;  it  is  not  so  in  any  case  of  simple  dropsy,  for  the  con- 
stant rule  is,  that  the  serosity  which  has  been  effused,  even 
while  remaining  composed  of  the  same  materials  as  the  serum 
of  the  blood,  contains  proportionally  more  water  than  this, 
and  much  less  of  the  organic  principles,  particularly  albumen. 
Thus,  in  sixteen  analyses  that  I  have  made  of  the  fluids  of 
diff"erent  dropsies,  I  found  for  the  maximum  of  albumen  the 
cipher  48,  and  for  minimum  the  cipher  4.    In  no  case,  there- 


OP  THE  BLOOD  IN  DISEASES.  115 

fore,  was  the  quantity  of  albumen  even  equal  to  that  which 
the  serum  of  the  blood  contains.  We  may  see  moreover,  by 
these  extremes,  how  much  the  proportion  of  albumen  con- 
tained in  tlie  fluid  of  dropsies  may  differ.  In  the  sixteen  ana- 
lyses, I  found  the  proportion  of  albumen  in  one  thousand  parts, 
represented  by  the  ciphers,  48,  47,  41,  40,  30,  28,  19,  15,  14, 
12,  12,  11,  10,  8,  6,  4.  In  six  other  analyses  of  serosity  taken 
by  puncture  from  the  tunica  vaginalis  of  the  testis  (cases  of 
hydrocele),  I  found  the  albumen  generally  more  abundant  than 
in  other  effusions  of  serosity :  thus,  in  these  six  cases,  there 
was  in  albumen  59,  55,  in  two  51,  49,  35.  The  highest  cipher 
in  these  six  cases  is  far  from  equalling  the  mean  of  albumen 
in  the  serum  of  the  blood.  I  have  not  observed  in  these  dif- 
ferent cases  that  the  seat  of  the  dropsy,  any  more  than  its 
cause,  exercised  an  influence  upon  the  greater  or  less  elevation 
of  the  cipher  of  albumen ;  but  it  was  different  as  to  the  more 
or  less  complete  state  of  integrity  of  the  constitution:  in  pro- 
portion as  this  remained  stronger  and  more  entire,  so  in  gene- 
ral did  the  serosity  elf  used  contain  more  albumen.  Here  is 
very  probably  the  reason  why  the  fluid  which  came  from  the 
tunica  vaginalis  was  usually  richer  in  albumen  than  that  of 
any  other  dropsy  ;  because,  in  all  these  cases  of  hydrocele,  the 
individuals  operated  upon  were  stiff  full  of  health  and  vigour. 
In  cases,  on  the  contrary,  where  I  have  had  occasion  to  exa- 
mine the  serosity  taken  from  the  abdomen  of  the  same  indi- 
viduals by  several  successive  tappings,  I  have  constantly  ob- 
served, that  the  more  frequently  the  operation  was  repeated, 
the  less  abundant  was  the  quantity  of  albumen  contained  in 
the  serosity,  which  fact  appeared  to  me  to  depend  upon  the 
progressively  increasing  debUity  of  the  constitution. 

As  to  the  water,  I  found  it  in  all  these  specimens  of  serosity  ' 
much  more  abundant  than  in  the  serum  of  the  blood ;  its  high- 
est cipher  was  986,  and  its  lowest  930:  consequently  the  ef- 
fused serosity  which  had  the  minimum  of  water,  still  contained 
more  than  the  serum  of  blood  most  highly  charged  with  this 
principle  :  in  this  serum,  in  fact,  we  have  found  the  maximum 
of  the  water  for  man  915;  the  minimum  725,  and  the  mean 


116  PATHOLOGICAL  H-EMATOLOGY. 

790.  Besides  it  is  in  the  serosity  taken  from  cases  of  hydro- 
cele that  we  have  met  with  the  least  amount  of  water ;  it  was 
in  one  of  these  cases  that  our  minimum  930  existed,  whilst 
the  maximum  of  water  for  these  same  cases,  was  947.  On 
the  contrary,  in  the  sixteen  other  cases  relative  to  serous  effu- 
sions whether  of  the  cellular  tissue,  of  the  pericardium,  of  the 
pleura,  or  of  the  peritoneum,  this  maximum  947  becomes 
almost  the  minimum ;  in  all  these  cases,  save  two,  we  find 
more  than  950  in  water,  4  times  from  950  to  960,  and  10  times 
from  960  to  986. 

Moreover,  all  these  samples  of  serosity  presented  us,  like 
the  serum  of  the  blood,  fatty  and  extractive  organic  matters, 
an  alkali,  and  alkaline  and  calcareous  salts.  The  quantity  of 
the  saline  matter  appeared  to  us  nearly  similar  to  that  of  the 
same  matter  in  the  serum  of  the  blood. 

With  the  exception  of  our  six  analyses  of  the  fluid  of  hydro- 
cele, all  the  others  are  relative  to  cases  where  the  dropsy  was 
the  result  of  some  obstacle  to  the  free  return  of  the  venous 
blood  towards  the  heart ;  I  much  regret  that  none  had  any 
connection  with  Bright's  disease.  In  these  cases  then,  as  in 
those  of  hydrocele,  there  is  separated  from  the  blood  propor- 
tionally more  of  water  than  of  albumen. 

I  have  already  said  that  the  proportion  of  albumen  separated 
from  the  blood,  becomes  more  considerable  when  it  is  an  in- 
flammatory process  which  has  provoked  the  effusion  of  sero- 
sity. This  may  be  proved  by  an  analysis  of  the  fluid  of  vesi- 
catories. 

Cases,  on  the  other  hand,  may  present  themselves  where  a 
fluid,  similar  to  serum  in  its  aspect,  and  like  it  alkaline,  fails 
to  show  by  re-agents  any  trace  of  albumen.  This  I  have  ob- 
served in  the  liquid,  clear  and  limpid  as  rock-water,  which  is 
contained  in  hydatids  of  the  liver.  This  fluid,  slightly  alka- 
line, was  not  sensibly  clouded  either  by  heat,  by  alcohol,  or 
by  nitric  acid.  It  contained  some  alkaline  chlorides,  some 
sulphates,  and  much  fatty  matter.*     Did  the  albumen  which 

*  The  fatty  matter,  which  -we  find  in  serosity  has  at  times  a  nature  dif- 


OF  THE  BLOOD  IN  DISEASES.  117 

was  absent  from  this  fluid  exist  in  the  parietes  of  the  Uving  sac 
which  contained  it? 

It  is  worthy  of  remark  that,  in  a  case  where,  in  the  same 
individual,  there  exists  simuUaneously  several  serous  efl'usions 
in  different  parts,  the  fluids  which  constitute  them  may  differ 
considerably  from  each  other,  as  to  the  quantity  of  albumen 
which  they  contain.  Thus,  in  a  female  attacked  with  an  or- 
ganic disease  of  the  heart,  there  were  30  parts  of  albumen  in 
the  serosity  of  the  pericardium,  while  there  were  but  4  in  the 
serosity  of  the  cellular  tissue  of  the  inferior  extremities. 


ARTICLE  Vir. 

Of  the  Blood  in  certain  diseases  commonly  called  Organic. 

I  HAVE  studied  the  composition  of  the  blood  in  five  cases  of 
hypertrophy  of  the  heart ;  in  all  of  them  the  amount  of  glo- 
bules was  natural,  as  was,  also,  the  albumen  of  the  serum. 
Once  only  the  fibrine  showed  a  slight  elevation,  represented 
by  4.  In  the  four  other  cases  it  preserved  its  physiological 
quantity,  being  represented  by  the  numbers  2.6;  2.7;  3.0; 
and  3.7,  respectively.  These  differences  in  the  proportion  of 
fibrine,  bore  a  strict  relation  to  those  observed  in  the  symp- 
toms themselves.  For,  in  the  cases  which  gave  2.6,  2.7, 
and  3.0  of  fibrine,  the  affection  of  the  heart  was  chronic,  and 
the  pulse  not  accelerated.  In  the  case  which  gave  4  of  fibrine, 
the  disease,  on  the  contrary,  presented  a  totally  different 
aspect.     The  symptoms  of  the  heart  disease  were  only  of  two 


ferent  from  that  of  the  same  matter  ordinarily  existing  in  the  serum  of  the 
blood.  It  is  thus  that  while  examining  with  the  microscope  the  fluid  of  a 
hydrocele  obtained  by  tapping,  I  found  in  it  crystals  of  cholesterine  assuming 
the  form  of  the  purest  parallelogram.  To  the  naked  eye  the  liuid  psesented 
us,  at  the  moment  of  its  escape  from  the  tunica  vaginalis,  a  clouded  appear- 
ance due  to  an  infinity  of  little  micaceous  spangles  which  it  held  in  sus- 
pension, and  a  great  part  of  which  were  precipitated  upon  the  bottom  of  the 
vessel  by  repose. 


118  PATHOLOGICAL  HiEMATOLOGY. 

months'  standing.     They  came  on  acutely  during  the  course 
of  an  attack  of  articular  rheumatism,  and  survived  it.     In  ad- 
:  dition  to  the  signs  of  hypertrophy,  a  very  distinet  bruit  de 
souffle  might  be  heard  at  every  contraction  of  the  ventricles. 

In  the  case  where  3.7  of  fibrine  was  found  in  the  blood, 
that  is  to  say,  one  of  the  highest  maxima  of  the  physiological 
state,  the  bleeding  was  performed  under  peculiar  circum- 
stances. There  was  no  articular  rheumatism,  but  a  sudden 
exacerbation  of  the  disease  of  the  heart;  the  movements  of 
this  organ  were  excessively  agitated,  a  very  strong  bruit  de 
frottement  was  heard  during  both  systole  and  diastole ;  the 
dyspnoea  was  extreme;  the  pulse  beat  108  in  a  minute.  The 
depletion  was  followed  by  great  improvement,  and,  after  a 
few  days,  the  rubbing  sounds  had  become  much  feebler. 
These  facts  teach  us  that  the  alteration  of  nutrition,  which 
produces  hypertrophy  of  the  heart,  does  not  affect  the  fibrine 
of  the  blood,  when  free  from  all  complication;  and  that  the 
increase  of  the  fibrine  takes  place  only  under  peculiar  circum- 
stances, and  accompanied  with  symptoms  which  recall  those 
of  the  inflammatory  affections. 

The  mere  deposit,  within  the  tissues,  of  the  morbid  sub- 
stances known  as  tuberculous,  scirrhous,  and  encephaloid,  and 
the  development  of  hydatids,  do  not  augment  the  fibrine.  It 
may  however,  happen  that  at  certain  periods  of  the  existence 
of  these  several  productions,  an  excess  of  fibrine  may  be  found 
in  the  blood,  but  that  is  because  some  other  morbid  condition 
has  supervened.  The  following  rules  may  be  laid  down  in 
regard  to  this  matter. 

So  long  as  tubercle  and  cancer  preserve  the  character  of 
hard  masses,  without  any  inflammation  around  them,  an 
analysis  of  the  blood  uniformly  gives  the  normal  quantity  of 
fibrine.  But,  as  the  softening  of  these  hard  masses  advances, 
and  a  process  of  elimination,  analogous  to  that  of  inflamma- 
tion, is  set  up  around  them,  the  blood  becomes  more  and  more 
charged  with  fibrine ;  so  that  the  excessive  formation  of  this 
principle  is  not  due  to  the  development  of  the  accidental  pro- 
duction, but  wholly  to  the  inflammation  excited  by  the  latter 


OF  THE  BLOOD  IN  DISEASES.  119 

at  certain  stages  of  its  existence.  This  is  a  new  proof  to  be 
added  to  the  many  others  which  show  that  the  process  engen- 
dering the  diflerent  accidental  productions,  such  as  tubercle, 
cancer,  melanosis,  hydatid,  &c.,  is  not  of  an  inflammatory 
nature. 

In  order  to  justify  the  principles  I  have  just  laid  down,  I 
will  first  cite  a  very  remarkable  case,  in  which  tubercles  de- 
veloped in  the  pia-mater  simulated  acute  meningitis  ;  but  the 
qualities  of  the  blood,  even  before  the  autopsy,  excited  doubts 
regarding  the  existence  of  the  latter  disease. 

A  sempstress,  24  years  of  age,  entered  the  hospital  of  La 
Charite,  May  27th  1841,  complaining  of  having  had  a  cough, 
and  shortness  of  breath,  for  some  time ;  she  stated  that  she 
suflered  from  continual  head-ache;  on  May  18th  she  met 
with  a  serious  disappointment,  and,  a  few  days  afterwards,  her 
headache  increased ;  from  that  epoch  slie  experienced  creeping 
chills.  From  May  23d  she  grew  more  seriously  ill;  on  that 
day  her  headache  was  unusually  severe,  and,  at  the  same 
time,  she  had  humming  noises  in  her  ears,  intolerance  of  light, 
and  bilious  vomiting.  From  the  27th  to  the  30th  of  May,  the 
symptoms  of  an  acute  cerebral  affection  grew  more  and  more 
distinct.  From  May  30th  to  the  day  of  her  death,  which  hap- 
pened June  5th,  she  uttered  piercing  cries  like  those  called 
hydrocephalic ;  there  were  delirium,  strabismus,  rigid  flexure 
of  the  limbs;  distressing  moans  and  convulsive  movements 
whenever  the  skin  of  the  trunk  or  limbs,  which  seemed  to  have 
its  sensibility  greatly  exalted,  was  at  all  rudely  touched ;  and; 
towards  the  close,  tetanic  rigidity  of  the  neck. 

At  the  autopsy,  the  pia-mater  was  found  thickly  studded 
with  tuberculous  granulations,  which  were  collected  most  nu- 
merously about  the  fissures  of  Sylvius.  In  no  other  part, 
either  of  the  brain  or  its  membranes,  was  any  appreciable 
alteration  detected.  Tuberculous  granulations  similar  to  those 
which  filled  the  pia-mater,  were  also  found  in  the  pleurae 
of  both  sides,  and  in  the  peritoneum,  both  of  which  mem- 
branes were  covered  with  them;  both  lungs  were  filled  with 
miliary  .tubercles. 


120  PATHOLOGICAL  HJEMATOLOGr. 

In  this  case,  then,  the  only  lesion  revealed  by  dissection 
was  the  equal  development  in  all  the  great  serous  membranes, 
and  in  the  lungs,  of  small  and  hard  tubercles,  with  no  signs  of 
inflammation  around  them.  The  anatomical  characters  of 
meningitis  were  completely  wanting. 

Let  us  look  now  at  the  analysis  of  the  blood  in  this  case. 
At  the  first  bleeding  we  found  3.0  of  fibrine,  and  at  the  second 
3.4 ;  so  that  the  quantity  of  this  principle  did  not  exceed  its 
physiological  limits.  While  the  patients  lived,  we  were  as- 
tonished at  this  result;  it  seemed  strange  that  in  a  disease 
which  appeared  to  us  to  be  acute  meningitis,  the  amount  of 
fibrine  should  not  be  increased;  the  autopsy  explained  this 
anomaly,  or  rather  showed  us  that  the  anomaly  was  only 
apparent.  What  evidence  could  be  stronger  than  this,  that 
whatever  may  be  the  extent  or  the  rapidity  of  the  formation 
of  tubercles,  it  does  not,  in  the  beginning,  augment  the  fibrine 
in  the  blood  ?  An  examination  of  the  blood,  in  cases  of  pul- 
monary consumption,  had  already  led  me  to  lay  down  this 
proposition,  in  the  first  memoir  I  published  with  M.  Gavarret. 
Since  the  publication  of  that  memoir,  we  have  collected  ad- 
ditional, and  confirmatory  cases,  of  which  the  following  is  an 
abstract. 

We  weighed  the  fibrine  obtained  from  the  blood  of  thirty 
tuberculous  patients,  drawn  at  thirty-three  different  bleedings. 
In  seven  of  these  patients  the  tubercles  were  still  crude ;  in 
nine  others  they  were  softening,  and  in  the  remaining  fourteen, 
there  were  cavities  in  the  lungs. 

The  six  patients  of  the  first  series  were  bled,  altogether,  nine 
times.  Seven  times  the  fibrine  was  found  to  be  normal,  vary- 
ing between  2.7  and  3.5.  Twice,  however,  the  fibrine  ex- 
ceeded its  physiological  quantity,  and  gave  the  numbers  4.8 
and  5,1.  But,  in  each  of  these  two  cases,  there  was  an  in- 
flammatory complication;  in  one  a  sub-acute  entero-colitis, 
and,  in  the  other,  a  bronchitis  of  much  greater  intensity  than 
is  usual  in  the  first  stage  of  phthisis. 

In  ten  bleedings  performed  on  the  nine  patients  of  the  second 
series,  we  already  come  to  different  results.     Nine  times  out 


OF  THE  BLOOD  IN  DISEASES.  121 

of  ten  the  fibrine  was  in  excess,  sometimes  very  slightly, 
hardly  reaching  4,  and  sometimes  varying  between  4  and  5. 
In  the  tenth  case,  there  were  only  3  parts  of  fibrine. 

In  fourteen  bleedings  performed  on  the  fourteen  patients  of 
the  third  series,  the  fibrine  was  in  excess  twelve  times,  but 
much  more  so  than  in  the  second  series.  The  minimum  found 
was  4.0,  and  that  once  only.  In  three  other  cases,  the  fibrine 
varied  between  4.4  ^nd  4.6  ;  in  all  the  others  it  was  between 
5.0  and  5.9. 

The  only  two  cases  of  the  third  series  which  did  not  follow 
the  rule  of  the  increase  of  fibrine,  must  be  regarded  as  excep- 
tional ;  the  subjects  of  them  were  far  gone  in  marasmus,  when 
we  attempted,  by  a  snmll  bleeding,  to  diminish  the  state  of 
half  asphyxia  which  they  presented  ;  and,  indeed,  they  were 
momentarily  relieved  by  it.  In  one  of  them  the  fibrine  was 
at  its  physiological  mean,  in  the  other  it  had  fallen  to  2.0. 

In  the  third  stage  of  phthisis,  therefore,  although  the  fibrine 
is  generally  in  excess,  there  are  yet  some  cases,  in  which  the 
exhaustion,  consequent  on  the  softening  of  the  tubercles,  is 
indicated  by  an  opposite  modification  in  the  amount  of  fibrine ; 
it  augments  during  the  process  of  elimination,  and  then  di- 
minishes, so  as  to  fall  even  below  the  lowest  limit  of  its  phy- 
siological state. 

Let  us  now  examine  how  far  the  quantity  of  globules  in  the 
blood  is  affected  by  pulmonary  consumption.  This  investi- 
gation will  lead  us  to  results  worthy  of  some  attention. 

From  the  very  commencement  of  pulmonary  tubercaliza- 
tion,  and  when  even  auscultation  can  hardly  detect  its  exist- 
ence, the  globules  are  already  diminished.  I  have  never  seen 
them  reach  even  their  physiological  average,  127,  in  any  case 
of  the  kind.  Their  highest  representative  was  122,  their  low- 
est 99,*  and  they  usually  varied  between  120  and  100,  ap- 
proaching the  latter  number  oftener  than  the  former.  The 
blood  of  persons,  then,  whose  lungs  are  beginning  to  be  tuber- 

•  This  minimum  was  found  in  the  patient  spoken  of  a  little  while  ago,  and 
whose  serous  membranes  and  lungs  were  thickly  studded  with  tubercles. 
11 


M 


122  PATHOLOGICAL  HEMATOLOGY. 

culous,  offers  that  particular  modification  which  belongs  to 
feeble  constitutions ;  they  are,  truly,  in  a  state  of  commencing 
ansemia,  and  their  blood  is  like  that  of  patients  who  have  been 
bled  several  times.  This  condition  of  the  blood  which  accom- 
panies the  first  stage  of  phthisis,  and  which,  to  all  appearance, 
precedes  it,  is  the  same  general  condition  found  in  every  case, 
where,  from  any  cause,  the  powers  of  life  have  lost  their 
energy.  What  need  is  there  of  saying' that  these  results  of 
analysis  agree  perfectly  with  clinical  observation?  Who  is 
not  familiar  with  that  shrunken,  pale,  and  feeble  look,  which 
belongs  to  most  consumptives,  even  in  the  first  stages  of  their 
malady  ?  There  are  yomig  girls,  who,  when  consumption  is 
imminent,  become  so  frail  and  pallJH,  and  yet  have  so  few 
invocal  symptoms,  that  it  sometimes  happens  that  the  nature  of 
their  disease  is  misunderstood,  and  that  they  are  supposed  to 
be  chlorotic.  On  the  other  hand,  there  are  cases  of  chlorosis 
which,  owing  to  the  complication  of  a  bronchitis,  or  of  a 
merely  nervous  cough,  have  thrown  the  most  accomplished 
observers  into  doubt,  and  made  them  apprehend  a  develop- 
ment of  tubercles. 

In  all  commencing  phthisis,  there  is,  then,  a  certain  degree 
of  anzemia ;  but  is  that  equivalent  to  saying  that  the  impover- 
ishment of  the  blood  is  the  sole  efficient  cause  of  tubercles? 
Certainly  not ;  for,  in  such  case,  a  greater  number  of  persons 
affected  with  phthisis  would  be  found  among  chlorotic  females 
than  are  so  found,  and  I  do  not  believe  that  girls  with  chloro- 
sis become  tuberculous  oftener  than  others.  The  decrease  of 
globules,  from  the  outset  of  consumption,  is  not,  then,  a  cause 
of  the  formation  of  tubercles,  but  we  must  regard  it  as  a  certain 
sign  that  this  disease  arises  during  a  marked  impairment  of 
the  constitution,  and,  by  adding  it  to  those  signs  furnished  by 
the  clinical  observation  of  all  ages,  it  helps  to  enlighten  us  in 
the  choice  and  application  of  modes  of  treatment. 

As  the  tubercles  of  the  lungs  advance,  however,  the  diminu- 
tion of  the  globules  grows  more  and  more  considerable,  and, 
at  last,  reaches  its  minimum  when  the  lungs  are  filled  with 
cavities.     Yet,  this  minimum  is  not  always  what  theory  might 


OF  THE  BLOOD  IN  DISEASES.  123 

lead  US  to  suppose  it.  It  would  seem,  indeed,  that  in  a  disease 
in  which  the  essential  organ  of  haimatosis  is  so  seriously  in- 
volved, and  has  become  so  unfit  to  fulfil  its  functions,  the  glo- 
bules ought  to  diminish  nearly  as  much  as  in  chlorosis.  But 
this  is  far  from  behig  the  fact.  In  the  second  and  third  stages 
of  phthisis,  I  have  not  yet  seen  more  than  a  single  case,  in 
which  the  globules  had  fallen  below  SO;  in  it  they  were  at 
72,  and  the  fibrine  at  5.5.  In  all  other  instances  they  varied 
from  80  to  100.  Is  it  not  strange  that  in  chlorosis,  without  any 
appreciable  alteration  of  the  lungs,  or  other  solid,  the  globules 
should  fall  even  lower  than  30,  while  their  minimum  is  at  72 
in  a  disease  in  which  it  should  seem  that  the  state  of  the  lung 
could  hardly  permit  the  formation  of  the  blood,  at  all  ?  And 
yet  not  only  do  the  globules  not  diminish  as  much  as  might 
be  expected,  but,  when  even  a  large  part  of  the  lung  is  de- 
stroyed, the  fibrine  increases,  and  the  temperature  of  the  body 
may  rise,  just  as  in  typhoid  fever,  or  acute  pneumonia.  I 
have  seen  the  temperature  rise  to  39°  and  40°  in  the  hectic 
fever  which  usually  accompanies  the  last  stage  of  phthisis. 

I  heard  a  bruit  de  souffle  in  the  carotids  of  one  only  of  the 
phthisical  patients  whose  blood  I  analyzed,  the  same  in  whose 
blood  the  globules  were  at  72.  This  patient  was  a  man  about 
thirty  years  of  age.  The  occurrence  of  the  carotid  souffle  in 
him  was  well  explained  by  the  extreme  poverty  of  his  blood 
in  globules ;  and  its  existence,  in  this  single  case,  goes  to  cor- 
roborate the  principles  we  have  already  laid  down  in  regard 
to  the  connection  of  this  sound  with  a  certain  decrease  in  the 
globules  of  the  blood. 

The  appearance  of  the  blood  in  the  several  stages  of  phthi- 
sis is  well  explained  by  the  changes  occurring  in  its  composi- 
tion. 

In  the  earlier  periods  of  the  disease  the  blood  offers  no  pecu- 
liarity, except  that  its  clot  is  generally  rather  small  and  dense, 
which  may  be  explained  by  the  moderate  quantity  of  its  glo- 
bules, and  its  preservation  of  a  normal  proportion  of  fibrine. 

But  with  the  progress  of  the  disease,  the  softening  of  the 
tubercles,  and  the  formation  of  cavities,  the  clot  becoming 


124  PATHOLOGICAL  H^MATOLOGr. 

smaller  and  smaller,  is  covered  with  a  bufFy  coat,  the  more 
perfectly  formed  in  proportion  to  the  degree  of  disorganization 
of  the  lung.  Two  circumstances  evidently  contribute  to  pro- 
duce this  buffy  coat ;  the  increase  of  fibrine  which  takes  place 
so  frequently  in  the  last  stage  of  phthisis,  and  at  the  same 
time,  the  progressive  decrease  of  the  globules;  so  that,  the^re 
are  two  causes  of  an  excess  of  fibrine  relatively  to  the  globules, 
and,  if  the  blood  flow  in  a  proper  manner,  a  huffy  coat  must 
necessarily  be  formed.  This,  indeed,  is  what  happens,  and  a 
buffy  coat  upon  the  surface  of  the  clot,  is  nearly  as  constant  in 
the  advanced  stages  of  phthisis,  as  in  pneumonia,  or  acute 
articular  rheumatism.  Considered  in  relation  to  the  causes 
which  govern  its  formation,  it  holds  a  middle  place  between 
the  chlorotic,  and  the  inflammatory,  buffy  coat. 

Let  us  now  examine  the  characters  of  the  blood  in  cases  of 
cancer.  It  may  be  inferred  from  the  cases  I  have  collected, 
upon  this  subject,  that  in  cancer,  as  in  tubercle,  the  fibrine  of 
the  blood  does  not  increase  until  the  scirrhous  or  encephaloid 
matter  is  advancing  to,  or  has  already  reached,  its  stage  of 
softening  and  destruction.  Yet,  if  the  cancer,  owing  to  its 
situation,  interfere  with  the  functions  of  an  organ,  which  is 
subservient  to  the  reparation  of  the  blood,  this  fluid  may  show 
a  diminished  quantity  of  fibrine.     But  that  is  a  peculiar  case. 

In  four  cases  of  cancer  of  the  stomach,  we  found  the  normal 
quantity  of  fibrine  three  times,  in  the  fourth  case  it  was  less 
than  this,  being  only  1.9. 

In  two  cases  of  cancer  of  the  liver,  we  found,  on  the  other 
hand,  a  certain  excess  of  fibrine  in  the  blood ;  in  one  case  3.7, 
and  in  the  other  5.0. 

In  the  first  case,  the  tumour  of  the  right  hypochondrium 
seemed  to  be  in  a  state  of  transition  between  immaturity  and 
softening:  although  usually  indolent,  it  sometimes  grew  pain- 
ful, and  then  a  temporary  fever  was  excited. 

The  symptoms  of  the  other  case  were  totally  different ;  a 
patient  had,  in  the  region  of  the  liver,  a  large,  very  painful 
and  indistinctly  fluctuating  tumour,  which  had  become  rapidly 
developed,  and  was  accompanied  whh  continual  fever.     The 


OF  THE  BLOOD  IN  DISEASES.  125 

liver,  in  its  whole  extent,  and  beyond  the  place  occupied  by 
the  tumour,  was  very  much  enlarged.  The  patient  presented 
all  the  signs  of  an  inflammatory  affection  so  distinctly,  that  we 
conjectured  the  existence  of  a  hepatic  abscess.  He  sank  rapidly, 
without  our  having,  a  few  hours  before  his  unlooked  for  death, 
seen  any  thing  to  indicate  so  sudden  a  termination.  It  was 
explained  by  our  finding,  on  dissection,  an  immense  eflusion 
of  blood  in  the  peritoneal  cavity.  The  source  of  this  blood 
•was  a  spongy  cancerous  projection,  completely  softened  and 
ulcerated,  and  which  occupied  the  free  edge  of  the  liver.  Nu- 
merous encfephaloid  masses,  reduced  to  a  sort  of  detritus, 
filled  the  parenchyma  of  the  liver,  as  well  as  several  branches 
of  the  vena-porta. 

In  a  case  of  cancer,  ascertained  by  dissection  to  be  ovarian, 
and  which  was  accompanied  with  fever,  and  acute  pains,  the 
fibrine  rose  to  4.5.  The  cancerous  mass  was  partially  softened, 
and  innumerable  vessels  traversed  it  in  every  direction.  There 
were  some  traces  of  a  slight  peritonitis  around  it. 

Finally,  in  two  cases  of  cancer  of  the  womb,  we  found  that 
very  different  numbers  expressed  the  quantities  of  fibrine  ;  viz. 
5.6  and  1.8.  But  the  progress  of  the  first  case  indicated  a 
state  of  pretty  intense  phlogosis;  the  whole  hypogastrium 
was  tense  and  painful,  and  there  was  constant  fever.  In  the 
second  case  there  was  complete  apyrexia;  the  patient  was 
thoroughly  exhausted  by  repeated  hemorrhage  from  the 
uterus.  This  was  the  remarkable  instance  of  which  I  have 
already  had  occasion  to  speak,  in  which  the  blood  contained 
only  2 1  parts  of  globules. 

I  have  not,  yet,  had  an  opportunity  of  analyzing  the  blood 
of  persons  affected  with  hydatids,  but,  in  sheep,  I  have  often 
made  this  examination,  and  have  always  fomid  the  quantity 
of  fibrine  normal,  where  no  other  aflection  complicated  the 
hydatids;  but  augmented,  whenever  an  inflammatory  process 
had  been  established  around  them.* 

»  Researches  into  the  composition  of  the  blood  of  certain  domestic  ani- 
mals, &c. 

11* 


W' 


126  PATHOLOGICAL  HJSMATOLOGT. 

In  the  several  cases  of  cancerous  disease  I  have  just  re- 
viewed, the  globules  of  the  blood  offered  nothing  remarkable,' 
except  the  progressive  diminution  tliey  undergo,  whenever 
the  organism  is  subjected  to  any  cause  whatever  of  exhaustion. 
The  profuse  hemorrhages  which  accompany  some  forms  of 
cancer,  the  defective  nutrition  which  must  result  from  the 
greater  number  of  cancers  of  the  stomach,  explain  why,  in 
many  diseases  of  this  nature,  the  blood  is  found  sparingly  sup- 
plied with  globules.  But  this  deficiency  does  not  appear  to' 
take  place  in  cancer,  as  in  tubercles,  at  the  commencement  of 
the  disease  ;  it  comes  on  late,  and  quite  accidentally,  from  the 
causes  just  enumerated.  The  predisposition  of  the  organism 
to  form  cancer,  is  not,  then,  like  its  tendency  to  form  tubercles, 
expressed  from  the  outset,  by  an  impoverishment  of  the  blood. 
It  should  be  remarked,  too,  that,  while  from  the  very  origin 
of  his  disease,  and  even  before  it  is  susceptible  of  demonstra- 
tion, the  tuberculous  patient  is  always  remarkable  for  his  de- 
bility and  paleness,  such  is  not  the  case  with  one  who  has 
cancer.  The  latter  may,  before  the  commencement  of  his 
disease,  and  during  its  first  stages,  present  every  variety  of 
constitution  and  temperament.  What  is  more  common  than 
to  see  a  cancerous  affection  in  persons  of  a  sanguine  tempera- 
ment, and  who  have  the  appearance  of  plethora  ?  And  what 
more  rare,  on  the  other  hand,  than  the  development  of  tuber- 
cles in  such  conditions  of  the  system?  Doubtless,  there  are 
not  a  few  cases  of  young  persons  becoming  tuberculous, 
amongst  those  who  are  fleshy,  and  have  a  ruddy  complexion, 
with  a  certain  appearance  of  strength  :  but  the  plethora  of  these 
individuals  is  deceitful,  they  have,  in  reality  a  lymphatic  tem- 
perament, and  if  their  blood  be  analyzed,  its  globules  are  found 
at,  or  even  a  little  below,  the  lowest  physiological  limit. 

There  is  ground  for  the  question,  whether,  when  once  the 
cancerous  cachexia  is  well  established,  there  may  not  be  an 
absorption  of  the  cancerous  detritus,  and  whether  some  traces 
of  it  may  not  be  detected  in  the  blood.  To  ascertain  this,  M. 
Gavarret  and  I  have,  several  times,  examined  with  a  mi- 
croscope, blood  taken  from  the  bodies  of  persons  who  had 


OP  THE  BLOOD  IN  DISEASES.  127 

died  of  various  cancerous  affections,  and,  in  some  instances, 
we  found  well  formed  globules  of  pus  in  the  blood.  These 
globules  were  not,  indeed,  portions  of  cancerous  matter ;  they 
were  merely  a  product  of  the  inflammatory  process,  which,  at 
a  certain  stage  of  the  disease,  is  developed  in  the  tissue  where 
the  cancer  originates.  Nevertheless,  this  is  a  fact  in  the  his- 
tory of  cancer,  important  to  be  known,  since  it  proves  the  pos- 
sibility of  a  purulent  infection  of  the  blood,  in  this  disease.  In 
a  case  of  osteo-sarcoma,  with  consecutive  production  of  a  large 
cancerous  mass  in  the  anterior  mediastinum,  we  met  with  a 
large  quantity  of  pus-globules  mixed  with  the  blood  in  the 
right  ventricle  of  the  heart.  But  along  with  these  globules 
we  found  other  bodies  of  an  altogether  peculiar  aspect,  and 
which  we  have,  in  this  case  only,  detected  in  the  blood.  They 
were  elliptical  lamellx,  with  a  granite-like  surface,  much 
larger  than  globules  of  pus,  and  of  a  much  more  regular  form 
than  simple  albuminous  flakes.  But  these  lamellas  were  not 
found  only  in  the  right  ventricle  mixed  with  pus-globules.  We 
found  a  great  many  of  them  in  a  little  of  the  ichorous  fluid 
taken  from  the  centre  of  the  cancerous  tumour  of  the  medias- 
tinum. Are  they,  then,  to  be  considered  as  denoting  the  pre- 
sence of  softened  cancerous  matter,  or  of  the  ichor  \  which  it 
furnishes  ?  We  can  only  say,  that  we  have  found  the  same 
latnellx  in  other  cancerous  masses.  The  subject  merits  further 
investigation. 

Before  concluding  this  subject,  I  may  add,  that  in  a  patient 
who  died  of  ulcerated  cancer  of  the  liver,  I  detected  the  pre- 
sence of  some  pus-globules  in  the  thoracic  duct;  the  contents 
of  this  vessel  were  reddish,  and,  along  with  the  pus-globules, 
the  microscope  showed  globules  of  blood,  the  most  of  them 
serrated  at  their  circumference,  and  very  distinct  from  globules 
of  pus. 

If,  then,  either  before  or  during  the  development  of  these 
various  accidental  productions,  one  of  the  elements  of  their 
formation  consists  in  some  change  effected  in  the  composition 
of  the  blood,  that  change  is,  apparently,  to  be  found  neither  in 
the  fibrine,  nor  in  the  globules,  nor  in  the  albumen,  but  rather 


128  PATHOLOGICAL  HEMATOLOGY. 

in  those  numerous  organic  substances,  mostly  of  an  undeter- 
mined character,  and  which  are  compreiiended  in  the  term 
extractive  matter.  But  are  new  substances  generated  ?  Are 
those  which  naturally  exist  modified  in  quantity  or  quality  ? 
What  happens  to  the  blood  when  tuberculous  matter,  instead 
of  increasing,  disappears,  leaving  a  calcareous  deposit  in  its 
stead?  When  accidental  productions  are  formed  of  wholly 
inorganic  substances,  as  by  an  accumulation  of  the  salts  of 
lime,  what  takes  the  place  of  these  salts  in  the  blood  ?  What 
happens  to  the  blood  in  those  cases  where  the  whole  vascular 
system  is  filled  with  ossific  concretions  ?  Or  what,  when  the 
bones  are  softened,  and,  being  deprived  of  a  large  portion  of 
their  phosphate  of  lime,  seem  reduced  almost  to  a  cartilaginous 
state  ?  Is  it  in  some  change  in  the  composition  of  the  blood, 
appreciable  by  analysis,  that  we  are  to  look  for  the  cause  of 
those  excessive  secretions  of  uric  acid  that  take  place  in  gout 
and  gravel?  Medicine  must  wait  for  something  of  its  advance- 
ment, till  these,  and  many  analogous  questions,  are  resolved. 


ARTICLE  VIII. 
Of  the  Blood  in  the  Neuroses. 

The  title  of  this  article  may,  at  first,  seem  singular.  For 
what  could  be  found  in  the  blood  in  diseases  whose  seat  is  the 
nervous  system,  whose  symptoms  are  the  various  disturbances 
of  the  functions  of  that  system,  and  which  it-  is  not  customary 
to  refer,  either  to  an  alteration  of  the  solids,  or  of  the  fluids? 
I  admit  these  notions,  and  yet  I  shall  endeavour  to  prove,  that 
even  in  the  neuroses,  the  study  of  the  state  of  the  blood  may 
be  important. 

Clinical  observation  has  long  since  demonstrated,  that  one 
of  the  most  powerful  causes  of  many  nervous  disorders,  is  a 
certain  degree  of  feebleness  of  the  constitution ;  whence,  the 
incontestable  advantage  of  a  tonic  treatment,  in  many  of  these 
diseases,  which  by  reviving  the  strength,  restores  the  equili- 


OP  THE  BLOOD  IN  DISEASES.  129 

brium  of  the  nervous  system,  and  removes  the  disorder  of  its 
functions. 

The  results  of  an  examination  of  the  blood  are  confirmatory 
of  those  furnished  by  clinical  experience. 

Thus,  it  is  found,  that  in  many  cases  of  neurosis,  the  glo- 
bules of  the  blood  are  very  scanty.  Now  it  is  well  known 
that  the  increase  or  decrease  of  the  globules  of  the  blood,  in- 
dicates the  vigour  or  feebleness  of  the  constitution.  If  the 
globules  be  diminished,  either  by  depletion,  or  by  insufficient 
nourishment,  the  nervous  disorder  will  certainly  be  aggra- 
vated; but  if  the  opposite  course  be  pursued,  in  all  proba- 
bility the  nervous  affection  will  be  mitigated.  In  this  way 
may  be  explained  the  happy  influence  which  the  ferruginous 
preparations,  and  substantial  and  nutritious  food,  exert  upon 
the  termination  of  certain  neuroses :  and  it  is  because  the 
globules  are  inevitably  diminished  by  depletion  and  diet,  that 
we  so  often  see  such  disturbance  of  the  nervous  functions 
follow  great  loss  of  blood,  and  a  too  prolonged  abstinence 
from  food. 

But  are  we  to  be  understood  as  declaring  that  such  is  the 
origin  of  every  neurosis  ?  Certainly  not ;  there  are  diseases 
of  this  sort,  and  many  of  them,  in  which  the  quantity  of  glo- 
bules in  the  blood  is  normal,  and  in  which,  even  the  aspect  of 
the  patient  gives  no  indication  of  constitutional  feebleness.  In 
these  cases,  the  blood  lias  nothing  to  do  with  the  production, 
nor  with  the  maintenance,  of  the  disease,  whose  etiology  must 
be  sought  elsewhere,  as  well  as  the  treatment  most  appropriate 
to  it.  These  various  facts  are  not  inconsistent  with  one 
another  ;  they  only  throw  new  light  on  one  of  the  most  im- 
portant of  medical  truths,  namely,  that  two  diseases  may  have 
identical  symptoms,  without  being  of  the  same  nature,  and 
that  however  close  their  resemblance,  they  may,  still,  require 
different  modes  of  treatment,  because  very  different  conditions 
of  the  economy  may  give  rise  to,  or  maintain,  them. 


THE    END. 


CYCLOPAEDIA  OF  PRACTICAL  MEDICINE. 

LEA    AND     BLANCHARD, 

PHILADELPHIA, 
WILLPUBLISH 

THE   CTCLOPiEDIA 
OF  PRACTICAL  MEDICINE; 

COMPRISINa 

^'  TREATISES   ON   THE 

NATURE  AND  TREATMENT  OF  DISEASES, 

MATERIA   MEDICA  AND  THERAPEUTICS, 

MEDICAL  JURISPRUDENCE,  &c.  &c. 

EDITED   BY 

JOHN  FORBES,  M.D.,F.R.S. 

Physician  in  Ordinary  to  her  Majesty's  Household,   &o. 

ALEXANDER  TWEEDIE,  M.D.,F.R.S. 

Physician  to  the  London  Fever  Hospital,  and  to  the  Foundling  Hospital,  &g. 

JOHN   CONOLLY,  M.D. 

Late  Professor  of  Medicine   in  the  London  University,  and  Physician  to  the  Hanwell 

Lunatic  Asylum,  &c.  ^ 

THOROUGHLY   REVISED,   WITH   ADDITIONS, 
BY  ROBLEY  DUNGLISON,  M.D. 

Professor  of  the  Institutes  of  Medicine,  &c.  in  the  Jefferson  Medical  College,  Philadelphia  ^ 

Lecturer  on  Clinical  Medicine,  and  Attending  Physician  at  the  Philadelpliia 

Hospital ;  Secretary  of  the  American  Philosophical  Society,  &c. 


TERMS    OF    PUBLICATION. 

THE  WOnK  VILL  BE  PRINTED  WMH   A  NEW   AND  CLEAR  TYPE,  AND  BE  COMPRISED  IN 

TWENTY-FOUR  PARTS,  AT  FIFTY   CENTS  EACH, 

FORMING,     WHEN     C  O  JI  1'  L  E  T  E  , 

FOUR  LAUGE  SUPKIMiOYAL  OCTAVO  VOLUMES. 

EMnUAClNG     OVER 

THREZ:    THOUSAND    U  N  X7  S  XJ  A  L  L  IT    ZiARGE    PAGES, 

IN    DOUBLE    C  O  L  U  .M  N  S . 
Any  person  forwarding  Twcnfi/  Dollars,  free  of  postage,  in  Current  Funds,  will  be  entitled  to 
two  copies.     The  whole  work  will  be  conipleled  during  the  year  1844. 


PUBLISHERS'   NOTICE 

TO    THE 

CYCLOPAEDIA  OF  PRACTICAL  MEDICINE. 

This  important  work  consists  of  a  series  of  Original  Essays  upon  all  subjects  of  Medicine,  contri- 
buted by  no  less  than  SIXTY-SEV^EN  of  the  most  eminent  practical  Physicians  of  Great  Britain  and 
Ireland,  and  among  them  many  of  the  Professors  and  Teachers  in  London,  Edinburgh,  Dublin  and 
Glas"-ow,  whose  reputation  conveys  a  high  and  just  authoritj'  to  their  doctrines.  Each  subject  hag 
been  treated  by  a  writer  of  acknowledged  eminence,  whose  particular  studies  have  eminently  fitted  him 
for  the  task  ;   and  all  the  articles  are  authenticated  with  the  names  of  the  authors. 

The  Editors  are  men  of  elevated  attainments,  and  in  the  undertaking  have  spared  no  personal 
pains  ;  in  the  hope,  by  uniformity  of  plan,  simplicity  of  arrangement,  and  the  iuirmony  and  con- 
sistency of  its  several  portions,  to  make  the  Cyclopicdia  represent,  fully  and  fairly,  the  state  of 
PRACTICAL  MEDICINE  at  the  time  of  its  appearance.  From  innumerable  foreign  and  domestic 
sources,  the  scattered  knowledge,  which  has  so  fast  accumulated  since  the  commencement  of  the 
present  century,  has  been  gathered  together  and  placed  at  the  command  of  every  reader  of  the 
En<"'lis!i  language  ;  and  whilst  the  great  claims  of  the  older  cultivators  of  Medicine  have  never  been 
forgotten,  the  labours  of  the  moderns,  and  more  particularly  of  the  French,  German,  and  Italian 
Pathologists,  bv  which,  conjointly  with  the  clVorts  of  British  and  American  Practitioners,  the  whole 
face  of  Practical  Medicine  has  been  changed,  have  attracted  the  most  diligent  and  thoughtful  attention. 

The  Editors  atHrm,  that  if  the  reader  will  take  the  trouble  to  inspect  the  mere  titles  of  the  articles 
contained  in  thc^ork,  comprising  nearly 

THREE   HUNDRED   ORIGINAL  ESSAYS 

of  known  and  distinguished  authors,  and  will  bear  in  mind  either  the  leading  physiological  divisions  of 
disease,  or  consider  them  with  reference  to  the  Head,  the  Chest,  the  Abdomen,  the  Surface,  or  the  gene- 
ral condition  of  the  body,  as  well  as  the  subjects  of  OBSTETRICAL  MEDICINE,  MATERIA 
MEDICA,  or  MEDICx\L  JURISPRUDENCE,  he  will  sufiicicntly  appreciate  the  care  bestowed  to 
make  the  Cyclopredia  satisfoctory  to  all  who  refer  to  its  pages,  and,  at  the  same  time,  strictly  a  book 
of  practical  reference.  No  subject,  it  is  believed,  immediately  practical  in  its  nature  or  ai>plication, 
has  been  omitted;   although  unnecessary  disquisition  has  been,  as  much  as  possible,  avoided. 

It  entered  consistently  and  properly  into  the  plan  of  the  Editors  to  admit  a  fur  wider  range  of 
subjects  than  appears  heretofore  to  have  been  considered  necessary  in  works  written  professedly  on 
the  Practice  of  Medicine,  but  a  range  comprising  many  new  subjects  of  extreme  importance  to  those 
engaged  in  practice,  or  preparing  for  it.     Such  are  the  subjects  of 

ABSTINENCE         5  CONTAGION  iEXPLORATION     OF!  PROGNOSIS 

ACUPUNCTURE   >  CONVALESCENCE  THE     CHEST    AND       PULSE 

AGE  COUNTER-IRRITATION       ABDOMEN  SOFTENING 

CHANGE  OE  AIR    CONGESTION    AND   DE-  GALVANISM  MEDICAL  STATISTICS 

ANTIPHLOGISTIC       TERMINATION     OE       HEREDITARY     TRANS-  STETHOSCOPE 

REGIMEN  BLOOD  MISSION  OP  DISEASE^  SUDDEN  DEAl'H 

ASPHYXIA  DERIVATION  INDURATION  ^SYMPTOMATOLOGY 

AUSCULTATION     PjIETETICS  IRRITATION  TEMPERAMENT 

BATHING  DISINFECTION  INFECTION  TOXICOLOGY 

BLOOD-LETTING    PHYSICAL  EDUCATION  LATENT  DISEASES  TRANSFORMATION 

MORBID  STATES    ELECTRICITY  1  MALARIA  AND  MIASMA  TRANSFUSION 

OF  THE  BLOOD  ENDEMIC  DISEASES        j  PERFORATION  TUBERCLE 

CLIMATE  EPIDEMICS  PSEUDO  -  MORBID       AP-^  VENTILATION 

COLD  j  EXPECTORATION  i      PEARANCES  ^MINERAL  WATERS 

and  those  of  various  general  articles  on  the  pathology  of  organs.  It  will  be  found,  too,  that  admirable 
articles  from  the  best  sources  have  been  inserted  on  the  important  subjects  of 

DISEASES  OF  WOMEN  AND  CHILDREN,  AND  OF  MEDICAL  JURISPRUDENCE. 

In  order,  however,  that  the  nature  and  value  of  the  work  may  be  fully  understood,  a  list  of  the 
articles,  and  the  names  of  the  contributors,  is  appended. 

The  excellence  of  this  work  on  every  topic  connected  with  Practical  Medicine,  has  been  admitted 
by  all  who  have  had  the  good  fortune  of  being  able  to  consult  it.  The  hope,  indeed,  expressed  by 
the  Editors,  has  been  amply  realized  —  "  I'hat  they  have  prepared  a  work  required  by  the  present 
Wants  of  medical  readers,  acceptable  Jo  the  profession  in  general,  and  so  capable,  by  its  arrangements, 
of  admitting  the  progressive  improvements  of  time,  as  long  to  continue  what  the  general  testimony 
of  their  medical  brethren,  as  far  as  it  has  hitherto  been  expressed,  has  already  pronounced  it  to  be, 

"A  STANDARD  WORK  ON  THE  PRACTICE  OF  MEDICINE." 


Such  a  work,  it  is  believed,  will  be  most  acceptable  to  the  members  of  the  profession  throughout 
the  Union,  as -there  exists,  at  this  time,  no  publication  on  Practical  Medicine,  on  the  extended  plan 
of  the  one  now  presented. 

To  adapt  it  to  the  Practice  of  this  country,  and  to  thoroughly  revise  the  various  articles,  the  atten- 
tion of 

PROFESSOR   DUNGLISON 

will  be  dJrocted  ;  whose  character  and  established  reputation  are  a  sure  guarantee  that  his  portion  of 
the  work  will  be  carefully  executed. 


CONTENTS  OF,  AND  CONTRIBUTORS  TO, 

THE  CYCLOP/EDIA  OF  PRACTICAL  MEDICINE. 


Abdomen,  Exploration  of,  Dr. 

Abortion Dr. 

Abscess Dr. 

Abstinence Dr. 

Achor Dr. 

Acne Dr. 

Acupuncture    ....  Dr. 

Age Dr. 

Air,  Cliange  of,     .     .    .  Dr. 

Alopecia Dr. 

Alteratives Dr. 

Amaurosis Dr. 

AmenorrhcEa    ....  Dr. 

Anaemia Dr. 

Anasarca Dr. 

Angina  Pectoris    .     .     .  Dr. 

Anodynes Dr. 

Anthelmintics  ....  Dr. 

Antiphlogistic  Regimen  Dr. 

Antispasmodics     .     .     .  Dr. 

Aorta,  Aneurism  of,      .  Dr. 

Aphonia Dr. 

Aphthae Dr. 

Apoplexy,  Cerebral,       •  Dr. 

Apoplexy,  Pulmonary,  .  Dr. 

Arteritis Dr. 

Artisans,  Diseases  of,   .  Dr. 

Ascites Dr. 

Asphyxia Dr. 

Asthma Dr. 

Astringents Dr. 

Atrophy Dr. 

Auscultation     ....  Dr. 

Rarbiers Dr. 

l>athing Dr. 

Beriberi Dr. 

Blood,  Morbid  States  of,  Dr. 

Bloodletting      ....  Dr. 


Brain,  Inflammation  of, 


Bronchitis Dr. 


pr. 


Bronchocele     .     .     .     . 

Bulla? 

Calculus 

Calculous  Diseases  .     . 

Catalepsy 

Catarrh 

Cathartics 

Chest,  Exploration  of,   . 
Chicken  Pox    .    .     .     . 

Chlorosis 

Cholera 

Chorea 

Climate 

Cold 

Colic 

Colica  Pictonum  .     .     . 

Coma 

Combustion,   Spontane- 
ous Human,    .     . 
Congestion  of  Blood 

Constipation      .     .     . 


Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 

Dr. 
CDr. 
^Dr. 

Dr. 

Dr. 

I- 

Dr. 

CDr. 

^Dr. 

Contao;ion Dr. 

Convalescence  .  .  .  Dr. 
Convulsions  ....  Dr. 
Convulsions,  Infantile  .  Dr. 
Convulsions,  Puerperal  Dr. 
Coryza Dr. 


Forbes. 
Lee. 

TWEEDIE. 

M.  Hall. 
Todd. 
Todd. 
Elliotson. 

ROGET. 

Clark. 
Todd. 

CONOLLY. 

Jacob. 

LococK. 

M.  Hall. 

Darwall. 

Forbes. 

Whiting. 

A.  T.  Thomson. 

Barlow. 

A.  T.  Thomson. 

Hope. 

Robertso.v. 

Robertson. 

Cluttereuck. 

Townsend. 

Hope. 

Darwall. 

Darwall. 

Roget. 

Forbes. 

A.  T.  Thomson. 

Townsend. 

Forbes. 

Scott. 

Forbes. 

Scott. 

M.  Hall. 

M.  Hall. 

QtTAIN. 

Adair  Crawford. 

Williams. 

And.  Crawford. 

Todd. 

Thos.  Thomson. 

Cumin. 

Joy. 

Williams. 

A.  T.  Thomson. 

Forbes. 

Gregory. 

M.  Hall. 

Brown. 

And.  Crawford. 

Clark. 

Whiting. 

Whiting. 

Tweedie. 

Whiting. 

Adair  Crawford. 

r.  Apjoun. 

Barlow. 

Hastings. 

Streeten. 

Brow.n. 

Tweed  IE. 

Adair  Crawford. 

LococK. 

LococK. 

Williams. 


Counter  Irritation     .    .  Dr. 

Croup Dr. 

Cyanosis Dr. 

Cystitis Dr. 

Delirium Dr. 

Delirium  Tremens    .     .  Dr. 

Dentition,  Disorders  of  .  Dr. 

Derivation Dr. 

Determination  of  Blood  Dr. 

Diabetes Dr. 

Diaphoretics     ....  Dr. 

Diarrhoea      .     .    .     .     s  t^  ' 

Dietetics Dr. 

Dilatation  of  the  Heart  .  Dr. 

Disease Dr. 

Disinfection      ....  Dr. 

Diuretics Dr. 

Dropsy Dr. 

Dysentery Dr. 

Dysmenorrhcea     .     .     .  Dr. 

Dysphagia Dr. 

Dyspnoea Dr. 

Dysuria Dr. 

Ecthyma Dr. 

Eczema Dr. 

Education,  Physical,      .  Dr. 

Electricity Dr. 

Elephantiasis  Arabum    .  Dr. 

Elephantiasis  Graecorum  Dr. 

Emetics Dr. 

Emmenagogues    .     .     .  Dr. 

Emphysema     ....  Dr. 
Emphysemaof  the  Lungs  Dr. 

Empyema Dr. 

Endemic  Diseases    .     .  Dr. 

Enteritis Dr. 

Ephelis Dr. 

Epidemics Dr. 

Epilepsy Dr. 

Epistaxis      .     .     •  .  •.   •  Df- 

Erethismus  Mercurialis  Dr. 

Erysipelas Dr. 

Erythema Dr. 

Expectorants    ....  Dr. 

Expectoration  ....  Dr. 

Favus Dr. 

rDr. 

Feigned  Diseases  .     .     •?  Dr. 

(.Dr. 

Fever.General  Doctrine  of.  Dr. 

"     Continued,  and  its  5 £) J 
Modifications,       (_ 

"      Typhus      ...  Dr. 

"      Epidemic  Gastric  Dr. 

**      Intermittent    .     .  Dr. 

"       Remittent  ...  Dr. 

"      Infantile  Remittent  Dr. 

Hectic    ....  Dr. 

"      Puerperal  .     .     .  Dr. 

"      Yellow      ...  Dr. 

Fungus  Hocmatodes  .     .  Dr. 

Galvanism Dr. 

Gastritis Dr. 

Gastrodynia      ....  Dr. 

Gastro- Enteritis    .    .    .  Dr. 

Glossitis Dr. 

Glossis,  Spasm  of  the,  .  Dr. 

Gout Dr. 

Haemorrhoids  ....  Dr. 


Williams. 

Cheyne. 

Crampton. 

Cumin. 

Pritchard. 

Carter. 

Joy. 

Stokes. 

Barlow. 

Bardsley. 

A.  T.  Thomson. 

Crampton. 

Forbes. 

Paris. 

Hope. 

CoNOLLY. 

Brown. 

A.  T.  Thomson. 

Daewall. 

Brown. 

LococK. 

Stokes. 

Williams. 

Cumin. 

Todd. 

Joy. 

Barlow. 

Apjohn. 

Scott. 

Joy. 

A.  T.  Thomson. 

A.  T.  Thomson. 

Townsend. 

Townsend. 

Townsend. 

Hancock. 

Stokes. 

Todd. 

Hancock. 

Cheyne. 

Kerr. 

BURDER. 
TWEEDIE. 

Joy. 

A.  T.  Thomson, 

Wilson. 

A.  T.  Thomson. 

Scott. 

Forbes. 

Marshall. 

Tweed  IE. 

Tweedie. 

Tweedie. 

Cheyne. 

Brown. 

Brown. 

Joy. 

Brown. 

Lee. 

GiLLKREST. 

Kerr. 

Apjohn. 

Stokes. 

Barlow. 

Stokes. 

Kerr. 

Joy. 

Barlow. 

Burns. 


CONTENTS,  &c.,  OP  THE  CYCLOPEDIA  OF  PRACTICAL  MEDICINE. 


Headach Dr.  Burder. 

Heart,  Diseases  of  the,       Dr.  Hope. 

Displacement  of  the,  Dr.  Townsend. 


Hetnatemesis 
Hemoptysis 
Hemorrhage 
Hereditary   Transmis 

sion  of  Disease 
Herpes    ;     .     . 
Hiccup     .     .     . 
Hooping-Cough 
Hydatids       .     . 
Hydrocephalus 
Ilydropericardium 
Hydropho'.)ia 
Hydrothorax 
Hypertrophy 
Hypertrophy  of  the 
Hypochondriasis 
Hysteria  .     .     . 
Icthyosia      .     . 
Identity   .     .     . 
Impetigo      .     . 
Impotence    .     . 
Incontinence  of  U 
Incubus  .     . 
Indigestion  . 
Induration    . 
Infanticide    . 
Infection 
Inflammation 
Influenza      .     . 
Insanity  .     .     . 
Irritation       .     . 
Ischuria  Renalis 
Jaundice       .     . 
Kidneys,  Diseases 
Lactation      ,     . 
Laryngitis    .     . 
Latent  Diseases 
Lepra       .     .     . 
Leucorrhoea 


nne 


D 


of, 


Dr.  GoLDiE. 
Dr.  Law. 
Dr.  Watson. 

Dr.  Bkown. 

Thomson. 


Dr.  A.  T 
Dr.  Ash. 
Dr.  Johnson. 
Dr.  Kerr. 
Dr.  Joy. 
Dr.  Darwai.l. 
Dr.  Baudsley. 
Dr.  Darwall. 
Dr.  Townsend. 
Heart  Dr.  Hope. 

Dr.  Pritchard, 

Dr.  CONOLLY. 

Dr.  A.  T.  Thomson. 
Dr.  Montgomery. 
Dr.  A.  T.  Thomson. 
Dr.  Beatty. 
Dr.  Cumin. 
Dr.  Wii.LiAMS. 
Dr.  Todd. 
Dr.  Cakswell. 
Dr.  Af.rowsmith. 
Dr.  Brown. 
A.  Crawford,  Dr.  Tweedie, 
Dr.  Hancock. 
Dr.  Pritchard. 
Dr.  Williams. 
Dr.  Carter, 

Dr.  BUKDER. 

Dr.  Carter. 
Dr.  LococK. 
Dr.  CnEYNE. 
Dr.  Chkistison. 
Dr.  Houghton. 
Dr.  LococK. 
Dr.  Houghton. 
Dr.  Stokes. 
Dr.  Venables. 
Dr.  Brown. 


Lichen     .     .     . 

Liver,  Inflammation  of, 

"      Diseases  of,     . 
Malaria  and  Miasma 
Malformations  of  the  Heart  Dr.  Williams. 
Medicine,  Principles  and  Cr,     n 

Pracliceof,      .     .      jDr.  Conolly. 

Melaena Dr.  Goldie. 

Melanosis Dr.  Carswell. 

Menorrhagia     .     .     .     .     Dr.  Locock. 
Menstruation, Pathology  of  Dr.  Locock. 

Miliaria, Dr.  Tweedie. 

Mortification     ....    Dr.  Ca^jswell. 

Narcotics Dr.  A.  T.  Thomson. 

Nephralgia  and  Neplmtis  Dr.  Carter. 
Neuralgia    .     .     .     .     .     Dr.  Elliotson. 
Noh  me  tangere,  or  Lupus  Dr.  Houghton. 

Nyctalopia Dr.  Grant. 

Obesity Dr.  Wili.ia.ms. 

Oedema Dr.  Darwall. 

Ophthalmia      ....     Dr.  Jacob. 
Otalgia  and  Otitis      .     .     Dr.  Burne. 
Ovaria,  Diseases  of  the      Dr.  Lee. 

Palpitation Dr.  Hope. 

Pancreas,  Diseases  of  the,  Dr.  Carter. 

Paralysis Dr.  R.  B.  '1'odd. 

Parotitis Dr. 

Pellagra Dr. 

Pemphigus Dr. 

Perforaiion  of  the  Hol-fj^ 

low  Viscera     .     .     "^ 
Pericarditis  and  Carditis    Dr.  Hope. 
Peritonitis  ....     Dr.  M'Adam,  Dr.  Stokes. 
Persons  found  Dead       .     Dr.  Beatty. 
Phlegmasia  Dolens  .    .    Dr.  Lee, 


Kerr. 
Kerr. 

CoRRIGAN. 

Carswell. 


Pityriasis     .....    Dr. 

Plague Dr. 

Plethora Dr. 

Pleurisy,  Plearitis,    .     .     Dr. 
Plica  Polonica  ....     Dr. 

Pneumonia Dr. 

Pneumothorax       .     .     .     Dr. 

Porrigo Dr. 

Pregnancy,  &c.,  Signs  of.  Dr. 

Prognosis Dr. 

Pseudo-morbid  Appear-  C  p 
ances      ....(_ 

Psoriasis Dr. 

Puerperal  Diseases    .     .     Dr. 

Pulse Dr. 

Purigo Dr. 

Purpura Dr. 

Pyrosis Dr. 

Rape Dr. 

Refrigerants      ....     Dr. 

Rheumatism     ....     Dr. 

Rickets Dr. 

Roseola Dr. 

Rubeola Dr. 

Rupia Dr. 

Rupture  of  the  Heart     .     Dr. 

Scabies Dr. 

Scarlatina Dr. 

Scirrhus Dr. 

Scorbutus Dr. 

Scrofula Dr. 

Sedatives Dr. 

Se.x,  Doubtful,      ...     Dr. 

Small-Pox Dr. 

Softening  of  Organs      .     Dr. 

Somnambulism  and  Ani-  9  r\- 
mal  Magnetism    .      C 

Soundness,  &,c.,  of  Mind    Dr. 

Spinal     Marrow,     Dis- 
eases of,      ... 

Spleen,  Diseases  of, 

Statistics,  Medical,    .     . 

Stethoscope      .... 

Stimulants 

Stomach,  Organic   Dis- 
eases of,      ... 

Succession    of    Inherit- 
ance—Legitima'fcy, 

Suppuration      .     . 

Survivorship     .     . 

Sycosis    .... 

Symtomatology     . 

Syncope  .... 

Tabes  Mesenterica 

Temperament  .     . 

Tetanus  .... 

Throat,  Diseases  of 

Tonics     .... 

Toxicology  .     .     . 

Transformations   . 

Transfusion      .     . 

Tubercle      .     .     . 

Tubercular  Phthisis 

Tympanites      .     . 

Urine,  Morbid  States 

Urine,  Bloody, 

Urticaria       .     . 

Uterus,  &c.  Patholog 

Vaccination       .     . 

Varicella      .     .     . 

Veins,  Diseases  of, 

Ventilation  .     .     . 

Wakefulness    .     . 

Waters,  Mineral, 

Worms    .... 

Wounds,  Death  from, 

Yaws 


Cumin. 
Brown. 
Barlow 
Law. 

CoRRIGAW. 

Williams. 

Houghton. 

A.  T.  Thomson. 

Montgomery. 

Ash. 

r.  R.  B.  Todd. 

Cumin. 

Hall. 

Bostock. 

A.  T.  Thomson. 

Goldie. 

Kerr. 

Beatty. 

A.  T.  Thomson. 

Barlow. 

Cumin. 

Tweedie. 

Montgomery. 

Corrigan. 

Townshend. 

Houghton. 

Tweedie. 

Carswell. 

Kerr. 

Cumin. 

A.  T.  Thomson.. 

Beatty. 

Gregory. 

Carswell. 

Pritchard. 

Pritchard. 

R.  B.  Todd. 

BfGSBT. 


Dr. 


the, 


of, 


of, 


Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 
Dr. 


Hawkins. 

Williams. 

A.  T.  TiioM«ow 

Houghton. 

montgomev  ■- 

R.  B.  ToDp.. 
Beatty. 

Cu.MIN. 

M.  Hall. 

Ash. 

Joy. 

Pritchari  , 

Symonds. 

Tweedie. 

A.  T.  Tuo,  -     , 

Apjohn. 

duesbury 

Kay. 

Carswelv. 

Clark. 

Keur. 

BuSTOCK. 

Goldie. 

IIoUGHTa 

Lee. 

(jREGORY 

Gregory. 

Lee. 

Brown. 

Cheyne. 

T.  Thom»   5. 

Joy. 

Beattt. 

Kerr. 


LEA    &    BLANCHARD'S    PUBLICATIONS. 


SIR  ASTLEY  COOPER  ON  HERNIA, 

WITH  ONE  HUNDRED  AND  THIRTY  FIGURES  IN  LITHOGKAI'HV. 

THE  ANATOMY  AND  SURGICAL  TREATMENT  OF  ABDOMINAL 
HERNIA,  BY  SIR  ASTLEY  COOPER,  BART.  Edited  by  C.  Aston  Kev,  Sur- 
geon to  Guy'ri  Hov«pital,  &.e. 

Ttiis  important  work  of  Sir  Astley  is  printed  from  tlio  aiitlmriscd  sccoiwi  edition,  published  in  London, 
in  laice  super-royal  folio,  and  edilid  liy  his  nephew,  Prole.-sor  Key.  It  contains  all  the  Plates  and  all  tlie 
Letlerpri'ss — there  are  no  onjissious,  interpolations,  or  inodiliralions  —  it  is  the  eoiiiph  te  Work  in 
ONE  I,AKGK  I.MI'EKIAL  OCI'AVO  VOl.UMli,  U'll  H  (AKl!  l:,()  I'KJL'UErf  ON  J  WKN'JXSIX 
PLATES,  .AND  t)Vl;K  4IKI  LARGE  PAGES  OF  LE  r'PEK-PR  ESS.  'J'I.e  eorrec  tne.ss  of  the  platcB  is 
guaranteed  by  a  revision  and  riose  exaniin.ition    under  the  eye  of  a  distnifrcjisNed  Surfieon. 

The  value  of  this  work  of  Sir  .\sth-y  Cm  pi-r's  is  so  universally  ac  know  hiified  hy  all  medical  men,  that 
in  presentine  this  edition  to  the  Anieriean  profession,  the  piililishers  nave  only  to  state  that  they  have 
used  their  utmost  endeavours  to  remhr  the  merhanical  e.vrutioii  of  the  work  worthy  its  c  xalted  reputa- 
tion, and  to  put  it  in  siich  a  form  and  at  such  a  price  as  to  place  it  « ithiu  tliu  reacli  of  tlRise  wlio  liave 
been  prevented  from  obtaining  it  by  the  size  and  rarity  of  former  editions. 

WATSON'S  TRACTICE  OF  rilYSIC. 

NOW  COMPLETE. 

LECTURES  OX  THE  PRINCIPLES  AND  PRACTICE  OF  PHYSIC,  DE- 
LIVEliED  AT  KING'S  COLLEGE,  LONDON,  BY  THOMAS  WATSON,  M. 

D.,  Fellow  of  the  Royal  Collrpe  of  Physician!-',  Physician  to  the  Middlesex  Hospital, 
&c.  &.C.,  embracing  Ninety  Lectures — cotnplete  in  one  octavo  volume  of  over  nine 
hundred  lar^e  and  condensed  pnges;  well  bound  in  leather. 

In  presenting  the  following,  from  numerous  commendations  of  this  work,  the  publishers  would  state 
thHt  it  is  amonc  the  cheapest  volumes  ever  otlered  to  the  profession. 

"  By  the  publication  of  this  work,  the  medical  literature  of  this  country  has  been  enriched  by  a  work 
of  standard  excellence,  which  we  can  proudly  hold  up  to  our  brethren  of  foreifiu  cMiuiitries,  as  a  repre- 
seulative  of  the  natural  state  of  Brilsji  medicine,  as  professed  antl  practiced  hy  our  most  enliiilitened 
physicians. — We  hesitate  not  to  declare  our  belief  that  for  sound,  trustworthy  principles,  and  substantial. 
<;ood  practice,  it  cannot  be  paralleled  by  any  similar  [iroductioii  in  any  othi-r  country. — We  would  advise 
no  one  to  set  himself  down  in  practice,  unprovided  with  a  cttpy."—  British  ^-  Foreign  Med.  Review. 

"  We  know  of  no  other  work  better  calculated  for  being  placed  in  the  hands  of  the  student,  and  for  a 
text-book,  and  as  such  we  are  sure  it  will  be  very  extensively  adopted." — Jim.  Med.  Journal. 

"  Open  this  Imce  and  welltinislied  volume  u  lierever  we  may,  the  eye  immediately  rests  on  something 
that  carries  value  on  its  front.  \Ve  are  impressed  at  once  with  the  strength  and  depth  of  the  lecturer's 
views,  and  he  gains  on  our  admiration  in  pmporticn  to  the  extent  of  our  ac(piaintance  with  his  profound 
researches.  Whoever  owns  this  Ixiok  will  have  an  acknowledgid  treasure,  if  tlie  combined  wisdom  of 
the  highest  authorities  bo  appreciated." — Boston  Med.  and  Hur/r.  Journal. 

CONDIE  ON  CHILDREN. 

A  NEW  WORK.  NOW  READY. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN,  BY  D. 
FRANCIS  CONDIE,  M.D.,  Fellow  of  the  College  of  Physicians,  Member  of  the 
American  Philosophical  Society,  &c.  &c.     In  one  volume,  8vo. 

"  Dr.  Condie  has  studiously  endeavoured  to  be  understood  by  students,  who  need  to  liave  the  elements 
of  Therapeutics  presented  to  I  hem  iu  a  comprehensiblr  form. 

The  volume  is  methodically  arranged  iu  two  parts.  In  Part  I.  are  considered  the  hygienic  inanage- 
ineut  of  ( hililren  ;  the  peculiarities  of  organization  and  fuiiclions  in  infancy  and  childhood  ;  p.iiliology 
of  infancy  and  childhood  ;  and  the  s<;iiiei(dogy  of  the  iliseases  of  infancy  and  childhood.  In  Part  II.  are 
embraced  disea.-es  of  the  digestive  organs;  the  monlh,  throat,  a'sopbai'us,  stomach,  iutesliues,  resjiira- 
tory  orL'ans,  nervous  system,  the  skin,  eruptive  fi-vers,  e  laneous  eriipliims,  nutrilive  functions,  and  uri- 
nary I'r^ans  ;  and  lastly,  congenital  .iltictnuis,  .ind  acciilenis  occurrini;  somi  alter  birth,  lint  this  is  only 
an  outline  of  the  subjccis  brought  under  sp:'cial  notice."— Ba.<(on  J\IrU.  and  Sur^.  Juurnal. 

"  ReL'ardiiig  this  treatise  as  a  whole,  it  is  more  complete  and  accurate  in  its  descriptions,  wliile  it  is 
more  copious  and  judicious  in  its  theraiieutical  directions  than  any  of  its  predecessors,  and  we  feel  per- 
suaded that  the  .■Vmirican  uK-dical  profession  will  very  soon  rigard  it,  not  only  as  a  very  good,  but  as 
the  verij  licst  '  Practical  Treatise  ou  the  Diseases  of  C'hiidren.'  "—jitn.  Med.  Journal. 

"  .An  excellent  Prnrtical  Treatise  on  the  Diseases  of  Children,  and  a  very  safe  guide  to  the  juvenile 
practitioner  and  student." — Med.  Kzamincr. 

HARRISON  ON  THE  NERVES. 

AN  ESSAY  TOWARDS  A  CORRECT  THEORY  OF  THE  NERVOUS 
SYSTEM,  BY  .lOIlN  HARRISON,  M.D.,  Profes.=or  of  Physiology  and  Pathology 
in  the  Medical  College  of  Louisiana.     In  one  volume  8vo, 


LEA    AND    BLANCHARD'S   PUBLICATIONS. 

A  NEW   WORK   ON    PRACTICAL    SURGERY, 
With  over  Two  Hundred  and  Fifty  Illustrations. 


A   SYSTEM   OF   PRACTICAL   SURGERY, 

BY  PROFESSOR  WILLIAM  FERGUSSON, 

OF    king's    college,    LONDON. 

ILLUSTRATED  BY  OVER  TWO  HUNDRED  AND  FIFTY  SPLENDID  CUTS, 

EXECUTED    BY    GILBERT,    FROM    DESIGNS    BY    BRAGG  ; 
WITFl  NOTES  AND  ADDITIONS, 

BY    GEORGE    W.    N  O  R  R  I  S,    M.D. 

One  of  the  Surgeons  to  the  Pennsylvania  Hospital.     In  One  Volume,  Svo. 

Tlie  object  and  nature  of  this  volume  are  thus  described  by  tlie  author: — "  Tlie  present  work  has 
not  been  produced  to  compete  with  any  already  before  the  Profession;  the  arrani;ement,  the  manner 
in  which  the  subjects  have  been  treated,  and  the  ilhistrations,  are  all  different  from  any  of  the  kind 
in  the  English  language.  It  is  not  intended  to  he  placed  in  comparison  with  the  elementary  syi^tenis 
of  Cooper,  Burns,  Liston,  Pymes,  Lizar,  aiid  that  e.\cellent  epitome  by  Mr.  Drnilt.  It  may  with 
more  propriety  bo  likened  to  the  Operative  Siirg-enj  of  Sir  C.  Bell,  and  tliitt  of  Mr.  Averill,  both  excel- 
lent in  their  day  ;  or  the  more  modern  ))roduclioii  of  Mr.  Hargrave,  am!  the  Practical  Surgery  fif  Mr. 
Liston.  There  arc  subjects  treated  of  in  this  volume,  however,  which  none  of  these  gentlemen  have 
noticed;  and  the  author  is  sutficiently  sanguine  to  entertain  the  idea  that  this  work  may  in  some 
degree  assume  that  relative  position  in  British  Surgery  which  tlie  classical  volumes  of  Valpeau  and 
Malgaigiie  occupy  on  the  Continent." 

The  publishers  commend  this  work  to  the  attention  of  the  Profession  as.one  combining  cheapness 
And  elegance,  wilh  a  clear,  sound,  gnd  practical  treatment  of  every  subject  in  surgical  science.  No 
pains  or  expense  have  been  spared  to  present  it  in  a  style  equal,  if  not  superior,  to  the  London  edition, 
and  to  match  the  edition  of  "Wilson's  Anatomy,"  lately  published,  and  "Churchill's  System  of  Mid- 
wifery," and  "  Carpenter's  Physiology." 

CHURCHILL'S    MIDWIFERY, 

"WITH    ONE    HUNDRED  AND   SIXTEEN    ILLUSTRATIONS. 


THEORY  AND  PRACTICE  OF  MIDWIFERY, 

BY  FLEETWOOD  CHURCHILL,  M.D.,  M.R.LA., 

Licentiate  of  the  College  of  Physicians  in  Ireland  ;  Physician  to  ths  Western  Lying  in  Hospital, 

Lecturer  on  Midwifery,  &c.  in  the  Richmond  Hospital  School  of  Medicine, 

Author  of  "  A  Treatise  on  the  Diseases  of  Females,"  &c.  &c. 

WITH  NOTES  AND  ADDITIONS,  BY  ROBERT  M.  HUSTON,  M.D. 

Professor  in  the  Jefferson  Medical  School  of  Philadelphia  ; 

WITH  116  ILLUSTRATIONS  FRO.M  DRAWINGS  BY  BAGG  AND  OTHERS, 

ENGRAVED    BY    GILBERT, 

"  Tliis  is  inconlcstably  one  of  the  very  best  books,  on  the  important  subject  on  whicli  it  treats.  The 
author  has  had  great  experience,  and  is,  withal,  an  a!)le  nnil  accomplislied  writer;  well  read  in  his 
profession,  and  gifted  ^^ith  a  vigorous  and  condensing  mind;  while  the  ."Vmcrican  editor  is  known 
as  a  skilful  practitioner  of  obstetrics,  and  well  acquaint.-d  witli  every  thing  that  has  been  said  or 
done  in  that  departni;-nt.  'I'he  notes  which  he  has  ailded  bear  ample  testimony  to  his  possessing 
those  qualifications.  The  work  does  not  consist  simply  of  the  ipse  dizit  of  the  author.  It  embraces 
a  brief  statement,  well  expressed,  of  the  views  of  the  best  autlnnities,  and  is  illustrated,  as  the  title 
sets  forth,  with  nnmcrons  woodcuts,  which,  by  the  way,  are  beautifully  executed.  ThJ-book  is 
altogether  well  'got  up,'  and  we  can  conscientiously  recommend  it  most  stroricly  as  an  excellent 
accompaniment  to  the  tyro  in  his  stmlies,  and  to  the  practitioner  when  beset  vvith  doubts  or  diffi- 
culties.   It  forms  a  fit  accompaniment  to  Wilson's  Anatomy,  and  Fergusson's  Surgery." 

PROUT   ON  THE  STOMACH. 

ON  THE  NATURE  AND  TREATMENT  OF  STOMACH  AND  RENAL  DISEASES; 

Being  an  Inquiry  into  the   Conne.xion  of  Diabetes,  Calculus,  and  the  other  Affections  of 
the  Kidney  and  Bladder,  with  Indigesiion; 

BY   WILLIAM    PPvOUT,   M.D.,  F.R.S. 

FELLOW    OF    THE    ROYAL    COLLEGE    OF    rHYSICIAN.S,    &C. 

From  the  Fourth  revised  London  Edition;  with  Coloured  Plates. 

"This  trenlise  was  received  wiih  so  much  favour  by  the  medical  profes^i.^n  in  Knclnnd.  that  wilhin  hree  yrars 
from  the  pulilicnliori  of  the  third  edili.in  nl  it,  a  fnutlh  w.is  m.-,de  nei-e^saiy  by  the  itideiisins  deinaiid.  Ti.o 
much  can  h.inl  y  bo  paid  iniis  praise,  as  a  practical  cs<Ay  upon  a  class  of  dcrainji'menls  but  lilt'e  studied,  and 
^■ss  unrtcr.stonil,  though  of  lieqiipnl  i.ccnircnte  iinicng  us:  for  every  enquiiins  eiuileal  nf  these  afleciions  -.vill 
fiiiri  1(1  Its  pages  valuable  precepts  h.r  their  manacetncrit,  and  many  cjaiislactory  explanations  of  the  obscure  and 
complex  phenoinena  usually  aitcndiuK  Ibern."— .^im.  Mcdtcal  Journal. 


LEA    AND    BLANCHARD'S    PUBLICATIONS. 

A  NEW  TEXT-BOOK  ON  CHEMISTRY. 


THE    E  L  E  ]\I  E  N  T  S    OF    C  H  E  M  I  S  T  K  Y : 

INCLUDING  THE  APPLICATION  OF  THE  SCIENCE  TO  THE  ARTS  : 

With  numerous  Illustration?. 
By  THOMAS  GRAHAM,  F.R.S.,  L.  &  ED., 

Professor  of  Chemistry  in  the  University  College,  Loudon,  President  of  the  Chemical  Society,  tec.  Sec. 

WITH  NOTES    AND  ADDITIONS,  BY  ROBERT   BRIDGES,  M.D, 

Professor  of  GontTal  and  Phaniiaooutic  Clu'iuistry  in  the  Philailelpliia  ('ollejii:  of  Pliariiiacy,  and  one 
of  the  Editors  of  the  American  Journal  of  Pliarinacy.     In  one  vol.  8vo. 

The  great  advancenn'nt  recently  made  in  Cheniistry  has  called  for  a  new  and  ixTfcct  treatise  on 
the  present  state  of  the  srit^nce.  ?iicli  this  work  is  pnsiiincd  to  li,\  wliili'  an  allempt  is  made  to 
apply  it  to  the  eliiciilation  of  the  }:reat  (picsfions  of  ve^'itable  and  animal  jihysitdogy.  Jt  fully  repre- 
sents the  progress  of  the  science  up  to  the  date  of  piihliiation. 

The  publislicrs  have  endeavoured  to  make  this  revised  edition  worthy  of  the  eminent  character  of  the 
author,  and  it  will  he  found  to  lia\e  nuincrons  additional  cuts  to  illnstrato  the  various  subjects. 

It  is  already  introduced  as  a  Text-book  into  several  Colleges,  and  has  universal  aj)probation. 

SIR  ASTLEY  COOPER'S  WORK 
ON  FRACTURES  AND  DISLOCATIONS,  WITH  CUTS,  ETC. 

A  TREATISE  ON  DISLOCATIONS  AND  FRACTURES  OF  THE  JOINTS. 
By  Sir  Astley  Cooper,  Bart.,  F.  R.  S.,  Sergeant  Surgeon  lo  ilic  King,  &c. 

A  new  edition  much  enlarged  ;  edited  by  P-RANSUY  15.  COOPKR,  F.  K.  S.,  Surgeon  to  Gny's  Hcspi- 
tal,  with  additional  Observations  from  Professor  John  t;.  VVarrfn.  of  Boston.  Willi  numerous  en- 
gravings on  wood,  after  d'.'si^ns  by  l!a:;g,  a  meniolr  and  a  splendid  portrait  of  tfir  Aslluy.    In  Ivol.Svo. 

The  peculiar  value  of  this,  as  of  all  Sir  Astley  Cooper's  uorks,  consists  in  its  eminently  practical 
character.  His  nephew,  Pransby  P.  Cooper,  from  his  own  experience,  has  added  a  nundier  (d"  cases. 
Beside  this,  Sir  .Astley  left  behind  him  very  considerable  addrlions  in  iMS.  for  the  express  purpose  of 
being  introduced  into  this  edition.  The  volume  is  embellisliid  with  ONE  HUNDRKI)  AND  TMIU'I'Y- 
THREE  WOOD  CUTS,  and  contains  tlic  tii>tory  of  no  li-ss  than  three  h;indr.-d  and  sixly-one  cases, 
thus  embodying  the  records  of  a  life  of  practice  of  the  .Author  and  his  various  editors.  Thire  are  also 
additional  Ob.servations  from  notes  furnished  by  John  C.  Warren,  M.  I).,  the  Professor  of  Anatomy  and 
Surgery  in  Harvard  University. 

WILLIAMS'  PATHOLOGY.-BY  CLYMER. 

PRINCIPLES  OF  MEDICINE,  COMPRISING  GENERAL  PATHOLOGY 
AND  THERAPEUTICS,  and  a  brief  general  View  ofEiiology,  Nosologv,  Semeiology, 
Diagnosis,  and  Prognosis.'  By  CHARLES  J.  B.  WILLIAMS,  M.D.,  F.R.S.,  Felbw 
of  the  Royal  College  of  Physicians,  &c.  With  Addiiions  and  Notes,  by  MEREDITH 
CLYMER,  M.D.,  Lecturer  on  the  Insiitute  of  Medi^'ine,  &c.     One  VoI.'8vo. 

"With  many  excellent  and  elaborate  treatises  on  the  details  of  Medicine,  we  have  scarcely  any 
which  treat  of  those  general  principles  in  the  nature  and  tre'.'ilmeiit  of  disease,  which  are  really  funda- 
mental in  the  practice  of  medicine.  V\'e  therefore  tliink  that  the  "  Priiiriji/m"  of  Dr  Williams  iseMti- 
tled  to  assume  a  station  along  with  the  works  of  Chnniel  and  Dubois,  in  the  French,  and  Neumann, 
ill  the  German.  It  is  without  a  competitor  in  our  language,  and  fills  most  successfully  a  decided  gap 
in  our  medical  literature.  The  actual  state  of  our  science  is  very  fairly  ri-prosented,  and  besides  a 
free  appropriation  from  the  writings  of  liis  contemporaries,  the  .Author  has  drawn  largely  from  his 
own  experience;  '  a  conliunal  observalion  of  disease  for  the  last  twenty  years  in  Hospital  and  private 
practice,'  atfording  him  abundant  opportunity  for  its  accumulation." 

BRODIE   ON  THE   JOINTS. 

PATHOLOGICAL  AND  SURGICAL  OBSERVATIONS  ON  THE  DISEASES 
OF  THE  JOINTS.  By  Sir  Benjamin  C.  Brodie,  Bart.,  F.  R.  S.,  Sergeant  Surgeon 
to  the  King,  &,c.  &c.  From  the  Fourth  London  Edition,  with  the  author's  alterations 
and  addiiions.     In  one  volume  8vo.,  cloth. 

To  both  the  practical  physician  ;ind  the  stiidrnt,  then,  this  little  volume  will  be  one  of  much  service, 
inasmuch  as  we  have  here  a  condensed  view  of  these  coniplicat-d  subjects  thoroughly  investigated  by 
the  aid  of  the  light  atTorded  by  modern  Pathological  Surgery. — JV.  i'.  Journal  of  Medicine. 

WALSIIE   ON  THE   LUNGS. 

THE  PHYSIC.\L  DIAGNOSIS  OF  THE  DISEASES  OF  THE  LUNGS.  By 
Walter  Hayle  Walshe,  M.  D.,  Professor  of  Pathological  Anatomy  in  University  College, 
London,  (fcc.  &.c.     In  one  volume  12mo.,  e.xtra  cloih. 

The  Rrilisli  and  Foreign  Medical  Review,  edited  by  Dr.  John  Forbes,  the  translator  and  annotator 
of  Ijaennec's  immortal  work,  says,  "  we  do  not  hesitate  to  say  that  there  exists  in  no  language  any 
work  on  the  physical  diagnosis  of  diseases  of  the  lungs,  suited  for  stndenis,  so  cbar  ami  precise,  and 
at  the  same  time  so  comprtdnnsive  and  practical  as  this.  It  is  one  which  no  b'ariier  in  auscultation 
can  fail  to  possess,  without  losing  advantages  eLsewhere  iinallainable  ;  and  it  is  one  which  very  few 
even  among  the  most  exp  rienced  auscultators  will  consult  without  adding  something  to  their  previ- 
ous stock  of  knowledge.  " 


LEA    AND    BLANCHARD'S   PUBLICATIONS. 

SIXTH  EDITION  OF 

SPECIAL  ANATOMY  AND  HISTOLOGY, 
BY  WM.  E.  HORNER,  M.D. 

PROFESSOR    OF  ANATOMY  IN   THE    UNIVERSITY    OF   FE.NNSYLVANIA,    MEMBER    OF   THE   IMVERIAL 
MEDICO-CHIRURGKAL  ACADEMY  OF  ST.  PETEKSBVRG,  OF  THE  AM.  PHIL.  SOCIETY,  &,C. 

In  Two  Volumes,  8vo. 

This  edition  has  undergone  a  complete  revision  hy  Prof.  Unrner,  and  perfected  from  recent  sources 
of  information.  The  prirtiou  on  HisTot.ocY  iiml  Histooeny  is  iwo-lliirils  new,  and  a  new  chapter  on 
Glandular  Structure  lias  been  added.  The  author  has  ileenied  ii  adwsaljle  Id  h.ive  an  Atlas  ok  .'\n.\- 
TOiMiCAi,  Plates  prepared,  to  illustrate  his  lectures.  This  has  been  undertaken  under  his  supervision, 
by  Dr.  H.  H.  Smith,  and  forms  an  additional  volume. 

A  TREATISE  ON  THE  DENTAL  ART, 

FOUNDED  ON  ACTUAL  EXPERIENCE. 

ILLUSTRATED  BY  TWO  HUNDRED  AND  FORTY-ONE  FIGURES  IN  LITHOGRAPHY, 
AND  FIFTY-FOUR  WOOD  CUTS  | 

By  B.  F.  MAURY,  DENTIST  OF  THE  ROYAL  POLYTECHNIC  SCHOOL. 

Translated  from  tlie  French,  with  Notes  and  Additions, 

BY    J.    B.    SAVIER,    DOCTOROFDENTAL   SURGERY. 

One  Volume,  8vo. 

This  work  is  used  as  a  Textbook  in  the  Baltimore  ('ollege  of  Dental  Snrjrery,  and  commends  itself 
to  the  Profession  from  the  great  reputation  of  the  a'lthor,  and  as  eniliracin^;;  the  latest  information  on 
the  subject.  Its  steady  demand  is  the  best  testimony  of  the  general  favour  with  which  the  professioti 
has  received  it.    It  is  in  fact  a  Cyclopaedia  of  the  science. 

CARPENTER'S  PHYSIOLOGY, 

"SFTITH    OVER    OriE    HU1\TDRED    SPLEUriD    ■WCCD    CUTS. 


PRINCIPLES  OF  HUMAN  PHYSIOLOGY, 

With  their  chief  applications  to  Pathology,  Hygiene,  and  Forensic  Medicine.     Especially 
designed  for  the  use  of  Students  ;  with  over  One  Hundred  Illustrations. 

BY  WILLIAM  B.  CARPENTER,  M.D., 

LECTURER  ON  PHYSIOLOGY  IN  THE  BRISTOL  MF.DICAL  SCHOOL,   &C. 

FIRST  AMER.  EDITIO.N.  WITH  ADDITIONS  BY  THE  AUTHOR,  AND  NOTES  AND  ADDITIONS 

BY  MEREDITH  CLYMER,  M.D. 

Lecturer  on  the  Institutes  of  Medicine,  Physician  to  the  Philadelphia  Hospital, 
Fellow  of  the  College  of  Physicians,  &.c.     One  Volume,  Octavo. 

8i!rThis  edition  of  Carpenter's  Physiology  has  been  most  carefully  prepared  by  Dr. 
Clymer,  at  the  request  of  Professor  Jackson,  for  his  lectures  at  llie  Universiiyof  Penn- 
sylvania. 

"Though  the  resources  of  the  author's  comprehensive  mind  are  ajiparetitly  devoted  to  the  advance 
ment  of  new  beginners  in  study,  there  is  a  splendid  exhibition  of  the  powers  of  analysj.s,  an 
uncommon  dejjroe  of  success  in  niakini;  abstruse  objects  clear,  and  iu  forcibly  impr-ssin;  upon  otiiers 
the  laws  of  life,  which  he  so  well  understands  himsidf,  whicli  will  -.'ive  eclat  lo  br.  (.'arpenter's  repu. 
tation,  when  he  will  be  insensible  to  praise.  All  who  can  allord  lo  have  a  good  system  of  Physioloiry, 
should  possess  this  ;  and  those  who  are  able  to  keep  pace  with  the  pro'.'ress  of  science  should  not  be 
without  it.  There  are  (iKS  pa,!;i!s,  larse  si/.e  octavo,  on  good  pap^T,  u  ith  a  type  ;is  distinctly  made  as 
it  can  be  executed.  Probably  this  edition  does  not  cost  more  than  oiir-ililrd  llio  price  asked  for  it  in 
England,  and  yet  it  is  superior  in  very  many  respects."— £o»7uji  Medical  and  Surgical  Journal. 


WILSON'S    DISSECTOR, 

■WITH   NU3VIEROUS    CUTS. 

THE  DISSECTOR,  OR  PRACTICAL  AND  SURGICAL  ANATOMY.  By  Erasmus  ^VI^soN, 
author  of  a  System  of  Human  Analoinv,  &c.,  edited  and  rearraiitfed  by  Paul  liitk  Goddard,  Ml)., 
Demonstrator  of  Anatomy,  &c.,  in  the  Universiiyof  Pennsylvania;  in  one  large  IJnio,  volur.ii!,  with 
numerous  llluslratioiis. 


FIG.  4. 


FIG.  5. 


&H 

-< 

H 

• 

W 

M 

^ 

-5-1 

tH 

-!l 

^ 

:?  ^  cu 

CJ 

o  -  ^ 

l-H 

o 

liP^H 

w 

H-1 

'^ 

w 

b 

o 

o 

^ 

E^ 

^ 

^ 

-< 

F I G .  7. 


ISWISj  iy 


t^.^'^/ llW  111'' 
lit  |:l::.l  . 


FIG.  4. 
A  Longitudinal    skction   of  a  Femuu, 

SHOWING  THE  CeLLULAR  STRUCTURE  AT 
ITS  EXTREMITY. 


FIG.  5. 
A  Longitudinal   section    of   a   Tieia, 

SHOWING 

1.  The  Compact  Structure. 

2.  Tlic  Cellular  Structure. 

3.  A  Transverse  section  of  the  Femur, 
showing  its  Compact  Suljstancc,  its 
Internal  Cellular  Structure,  and  the 
Medullary  Canal. 


FIG.  6. 

The  Texture  of  a  Bone  as  shown  in 
a  humkrus,  after  maceration  in 
dilute  acid. 

1.1.  The  Compact  Matter  as  usually 

seen. 
2.  2.  The  same  split,  so  as  to  show  the 

Lon<ritiidinal  Fibres  composing  it. 
I    a.   The  fnternal  Cellular  Matter. 
4.   'J'he  l>one  seen  under  its  Articular 

Curtilage. 


FIG.  7. 
A  VIEW  or  THE  Concentric  Lamellae  of 
THE  Compact  Matter  of  a  Bone. 


LEA    &    BLANCIIARD'S    PUBLICATIONS. 

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DISEASES  OF  CHILDREN. 

A  TREATISE  ON  THE  PHYSICAL  AND  MEDICAL  TREATMENT  OF 
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This  edition  embodies  the  notes  and  additions  prepared  by  Dr.  Dewees  before  his  death,  and  w  ill  be 
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The  objects  of  this  work  are,  1st,  to  teach  those  who  have  the  charge  of  children,  either  as  parent  or 
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by  pointing  out  the  duties  which  the  parent  or  the  uiiardian  owes  for  this  purpose,  to  this  interesting  but 
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ablo  a  huig  experience  to  those  objects  of  our  affection  when  they  become  diseased.  In  attempting  this, 
Ihe  author  has  avoided  as  much  as  possible,  "  technicality ;"  and  has  given,  if  he  does  not  flatter  liims(df 
too  much,  to  each  disease  of  which  he  treats,  its  appropriate  and  desisnating  characters,  with  a  fidelity 
that  will  prevent  any  two  being  coni"ounded  together,  with  the  best  mode  of  treating  them,  that  either 
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of  this  book  in  all  families. 

A  NEW  WORK,— DUNGLTSON'S 
THERAPEUTICS  AND  MATERIA  MEDICA. 

GENERAL  THERAPEUTICS  AND  MATERIA  MEDICA,  ADAPTED  FOR 
A  MEDICAL  TEXT-BOOK,  BY  ROBLEY  DUNGLISON,  M.D.,  Professor  of 
Institutes  of  Medicine,  &.C.,  in  2  vols.  8vo. — Just  ready. 

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order  of  th<;ir  efficacy  as  Therapeutical  agents. 

DEWEES'   MIDWIFERY. 

A  COMPENDIOUS  SYSTEM  OF  MIDWIFERY,  chiefly  designed  to  facilitate 
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WITH  ONE  HUNDRED  AND  SEVENTY  ILLUSTRATIONS. 

A   SYSTE.M    OF    HUMAN  AN.\TOMY,  GENERAL   AND    SPECIAL,   BY 

ERASMUS  WILSON,  M.D.,  Lecturer  on  Anatomy,  London.  The  American  edi- 
tion, edited  by  Paul  B.  Goddard,  A,J\].,  M.D.,  Demonstrator  of  Anatomy  in  the  Uni- 
versity of  Pfnnsylvnniti,  &,c. ;  vvitli  one  liundred  and  seventy  illut^trations  on  wood,  by 
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"  Ar\  Ricffant  edition  of  one  of  t!in  most  useful  and  accurate  Systems  of  Anatnmical  Science,  wliicli 
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wi^V'N/N^"   '^yVN 


IIOrE  ON  THE   HEART -WITH   TLATES. 

A  TREATISE  ON  THE  DISEASES  OF  THE  HEART  AND  GREAT  VES- 
SEI.S,  AND  ON  THE  AFFECTIONS  WHICH  MAY  BE  MISTAKEN  FOR 
TliEM,  COMPRISING  THE  AUTHOR'S  VIEW  OF  THE  PHYSIOLOGY 
OF  THE  HEART'S  ACTION  AND  SOUNDS,  AS  DEMONSTRATED  BY 
HIS  EXPERIMENTS  ON  THE  MOTIONS  AND  SOUNDS  IN  1830,  AND 
ON  THE  SOUNDS  m  1834-^5,  BY  J.  HOPE,  M.D.,  F.R.S.,  of  St.  George's 
Ho,<pital ;  formerly  Senior  Physician  to  the  Marylebone  Infirmary;  Extraordinary 
Member,  and  formerly  Pre.sident,  of  the  Royal  Aledical  Society  of  Edinburgh,  &c. 
First  American  from  the  Third  Ijondon  Edition,  with  Notes  and  a  detail  of  recent 
Experiments,  by  C.  \\\  Pennock,  M.D.,  Attending  Physician  to  the  Philadelphia 
Hospital,  Blocidey.     In  1  vol.  8vo. 

"  'I'lie  addition  of  one-third  of  new  matter  to  tlie  present  volume,  and  the  care  with  which  tlie  whole 
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coiitineuts,  by  the  sale  of  no  less  than  si.x  or  seven  editioiis  and  translations  in  as  many  years." — Kx- 
trad  from  I'rcJ'ace. 

MEDICAL   REMEDIES. 

NEW  REMEDIES.  THE  METHOD  OF  PREPARING  AND  ADMINIS- 
TERING THEM;  THEIR  EFFECTS  UPON  THE  HEALTH  AND  DISEASED 
EC(3NOMY,  &c.  (fee,  BY  PROFESSOR  ROBLEY  DUNGLISON.  Fourth  edi- 
tion, broui/ht  up  to  1843.     In  one  volume  octivo. 

This  work  contains  articles  that  have  been  recently  introduced  into  the  Materia  iVIedica  ;  or  old  articles' 
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tb-ir  |)ri.|i''rlics  are  only  brirlly  ndcrri',!  to.  In  this  work,  the  e.vperieuce  of  imiividuals  is  extensively 
{iiven,  uith  refiicnce  to  tlw  iiri:;inal  papers.  I'ndir  Iodine,  lur  r'xainple,  all  the  infnrmalion — pharma- 
ceutical and  ther.'i|)eu!ical — nj)  to  ilie  liuie  uf  th"  publication  of  the  work,  is  afforded,  with  the  prescrip- 
tion? thai  have  been  proposer!  by  varinus  tdi.-;ervi  rs;  each  successive  edition  has  iiicorporatiid  Willi  it  tlio 
result  (d'  recent  evperienee,  and  is  lheri;fore  "  new." 

MIDVvlFERY  WITH  CUTS,  A  LATE  WORK. 

A  SYSTEM    OF    ^^DW1FERY,  WITH    NUMEROUS    WOOD   CUTS,  BY 

EDWARD  RIGP.Y,  M.D.,  Phy.s;ciMn  to  the  General  Lying-in  Ho.^pital,  Lecturer  on 

.Miduiferv  at  St.  B.-rtisnlnmevv's  Hnj;pital.  iS:c.,  with  notes  and  additional  Illustrations, 

by  in  .American  Practitioner.     In  one  voliimo. 

The  late  ProlVssor  Dewees,  into  whose  hands  this  volume  was  pl.nced  a  few  weeks  before  his  death,  in 
r.'turninjj  it,  c.vpreKsed  the  most  I'avonrahle  opinion  of  its  merits.  The  judgment  of  such  high  authority 
slinulil  coiiiiiienil  it  to  general  ravoiir. 

DISEASES  OF  FEMALES. 

A  TRE.NTISE  0.\  THE  DISE.ASFS  OF  FEMALES,  WITH  NUMEROUS 
ENGRAVINGS,  BY  THE  LATE  PROFESSOR  W.  P.  DEWEES,  in  one  volume 
8vo — the   Eighth   Edition,  revised  and  corrected. 


r 


LEA    &    BLANCHARD'S    PUBLICATIONS. 


DISEASES  OF  FEMALES,  PREGNANCY  AND  CHILDBED. 

THK  PRINCIPAL  DISEASES  OF  FEMALES,  TOGETHER  WITH  THE 
DISEASES  INCIDENT  TO  PREGNANCY  AND  CHILDBED,  CHIEFLY  FOR 
THE  USE  OF  STUDENTS,  BY  FLEETWOOD  CHURCHILL,  M.D.,  Lecturer 
on  .Midwifery  and  Diseases  of  Women  and  Cliildren,  in  the  Richmond  Hospital,  School 
of  Medicine,  &-C.  *Sz,c.,  with  Notes  and  Additions  by  R.  M.  Huston,  M.D.,  Professor,  &,c. 
in  the  Jeflerson  Medical  College.  Second  American  Edition,  in  1  vol.  8vo. — Just  rtady. 


./v/VA/v/vrv/v/x/v 


DUNGLISON'S  PHYSIOLOGY  -  WITH  ILLUSTRATIONS. 

HUMAN  PHYSIOLOGY,  ILLUSTRATED  WITH  THREE  HUNDRED 
ENGRAVINGS  ON   WOOD;  BY  PROFESSOR  ROBLEY  DUNGLISON;  the 

fifth   edition   with  numerous  additions  and  modifications,  in  2  vols.  8vo. 

This  wnrk  is  occupied  with  the  functions  executed  by  liealthy  man.  It  cmt)races  a  general  exposition 
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of  patlndogy,  hygiene  ami  tlierapeutics.  It  treats  moreover,  of  the  anatomy  of  the  organs  so  far  as  is 
necessary  for  a  full  understanding  of  the  functions;  and  is  largely  illustrated  by  appropriate  engravings. 
The  last  edition  contains  ninety  additional  illustrations  to  elucidate  either  topics  that  have  been  aln.'ady 
touched  upon  in  the  work,  or  such  as  are  new.  Every  elibrt  has  been  made  to  placu  the  work,  in  all 
respects,  on  a  level  with  the  existing  state  of  the  science. 

THE   DISEASES   OF   THE   EYE. 

A  TREATISE  ON  THE  DISEASES  OF  THE  EYE,  BY  W.  LAWRENCE, 

Surgeon  E.xtraordinary  to  the  Queen,  <S:.c.,  from  the  last  London  Edition,  with  numerous 

additions,  and  si.xty-seven  IHuslrations,  many  of  which  are  from  orifjinal  drawings. 

By  IsA.\c  Hays,  M.D.,  Surgeon  to  the  Wills  Hospital,  &c.,  &.C.,  in  1  vol.  8vo. — 

Jusl  ready. 

The  character  of  this  work  is  loo  well  established  to  require  a  word  of  commendation— it  is  justly 
considered  the  best  on  the  sul.'ject.  The  present  is  a  reprint  of  the  last  Loudon  Edition,  which  appeared 
in  1841,  completely  revised  and  greatly  enlarged  liy  the  author— and  to  it  considerable  additions  have 
been  made  by  the  editor.  Several  subjects  omitted  in  the  original  are  treated  of  in  this  edition,  on  which 
occasion  free  use  has  been  made  of  the  wcuk  of  JNIackenzie,  to  wliich  is  added  the  editor's  own  exi)eri- 
ence,  derived  from  many  years'  attention  to  the  subject. 


■\/^^^/\j  V>X/*j  \j'\.'N/N/^ 


THE  URINARY  ORGANS,  &c. 

LECTURES  ON  THE  DISEASES  OF  THE  URINARY  ORGANS,  BY  SIR 
B.  C.  BRODIE,  BART.  F.R.S.  PVoi/i  the  Third  London  Edition,  with  alterations 
and  additions,  a  small  Bvo.  volume. — Now  ready. 

The  work  has  throiiiihout  been  entirely  revised,  some  of  the  author's  views  have  been  modified,  and  a 
cour^iderable  proiiortion  of  new  matter  lias  been  added,  among  which  is  a  Lecture  on  tile  Operation  of 
Lithotomy. 

RICORD  ON   VENEREAL. 

A  PRACTICAL  TRF.ATISE  ON  VENERE.^L  DISEASES;  OR,  CRITICAL 
AND  E.XPKRIMENTAL  RESEARCHES  ON  INOCULATION,  APPLIED  TO 
THE  STUDY  OF  THF-SK  AFFECPIONS;  WITH  A  THP.RAPEUTiCAL 
SUMMARY  AND  SPECIAL  FORMULARY,  BY  PH.  RICORD,  M.D..  Surgeon 
of  the  Vtjncroal  Ho.'^pital  of  Paris,  Clinical  Professor  of  Special  Pathology.  &c. 
Translated  from  the  French,  by  Henry  Pilkington  Dfuinmond,  M.D.,  in  one  volume. 
— Now  ready. 

LAWRENCE   ON   RUPTURES. 

A  TREATISE  ON  RUPTURES,  BY  W.  LAWRENCE,  F.R.S.,  Author  of  a 
Treatise  on  the  Diseases  of  the  Eye,  &c.  i^'c,  from  the  Fifth  London  Edition,  consi- 
derably enlarged.     In  1  vol.  Bvo — Now  ready 

The  peculiar  advantage  of  the  treatise  of  Mr.  Lawrence  is,  that  he  explains  his  views  on  the  anatomy 
of  hiTiiia,  and  the  (lilicrcnt  varieties  of  the  disease,  in  a  manner  wliirli  renders  his  book  iH'Ciiliaily  useful 
to  the  sludi'iit.  It  must  be  siipcrtluoMs  to  cxpri'ss  our  opinion  of  its  value  to  the  siir^'iral  practitioner. 
As  a  treatise  on  hernia,  prcsentiii;.'  a  coniplele  view  uf  the  literature  of  the  subje<a,  it  stands  in  the  first 
rank. — Kdinburijli  Medical  and  Suriricat  Journal. 


LEA    &    BLANCHARD'S    PUBLICATIONS, 


MEDICAL  LEXICON,  BROUGHT  UP  TO  1844 

A  NEW  DICTIONARY  OF  MEDICAL  SCIENCE;  Containinj^  a  concise 
account  of  the  various  Subjects  and  Ttrm?,  with  the  French  ancl  other  Synoiiymcs-,  atid 
Fnrniulffi  tor  vnrioiis  Officinal  ami  Euipirical  Propnrations.  &c.  Fourth  Edition,  brouijiit 
up  to  1844.  BV  RORLEY  DUNGLISON,  M.D.,  Professor  in  the  Jcffirson  Medical 
College,  &c.      in  One  Vohnne,  royal  8vo. 

"  Tlii^  pri'si.'tit  umlcrtnkins  ^vns  «iij;f;;osti'(i  liy  tlic  frcqn'-iit  rniiipl»iiits.  ninilc  by  tliR  nuflinr'i-  [iiipils,  tiKit 
llii-y  wen-  iitialili'  Id  iiifii  with  inrirmation  on  iiMiinrniis  tii|iirs  nf  l'rof(;s?ioiial  Inquiry, — f:<|iucially  uT 
riT.erU  iniriiilu<'tii>ri. — in  the  niciliral  ilirti'marii's  niCL'ssiMt'  In  lln-ni. 

•'  It  may.  iiidi'od,  lu;  cirrrclly  nlhrnii-il,  tliat  wo  liavi-  ini  iliclinnary  ormcilical  s'llrjccts  ami  torinj  wliich 
can  111!  Iimki'il  II poll  as  ailnptrd  to  tin-  Flati-  of  lliu  sciriicc.  In  proof" of  this  I  lie  atitlior  iioi-d  Imt  to  remark, 
llial  Ik;  lias  found  oica.^ion  |o  add  .several  tliousaml  iMedical  'IVrins,  wliicli  are  not  to  be  liift  Willi  ill  the 
only  iiiediial  li'.sicon  at  Ihi.s  lime  in  circulation  in  this  country. 

"The  present  c-ditioii  will  he  found  to  rnntaiu  many  tiumsand  Terms  more  tlian  the  first,  and  to  have 
trxperieiiced  numerous  Additions  and  .ModifieatioMs. 

"  The  author  s  id)jeet  has  not  heeii  to  make  the  work  a  mere  lexicon  or  dictionary  of  terms,  hut  to 
alTlird,  under  each,  a  coiiilen.'^ed  view  of  its  various  medical  relations,  ami  thus  to  render  the  work  an 
epiloiiie  of  the  e.xislinii  cmnlition  of  Medical  Stiiuice." 

This  \ew  Editi'Ui  includes,  in  the  ho.ly  of  the  work,  the  Index  or  Vocahu'ary  of  pynonymes  th;it  was 
in  lh<'  former  Kililions  pi  inted  at  the  em!  of  ihi'  Volume',  and  embrace.s  many  Corrections,  with  the  addi- 
lion  of  over  Two  't'liouband  New  Words  and  Terms. 

PEREIRA'S  MATERIA  MEDICA, 

EniTED  nV  DK.  CARSON,  WITH  NEAU  THRICE  HUNDRED  ENGRAVINGS  ON  WOOD. 

EEE.MENTS  OF  MATERL\  MEDICA  AND  THERAPEUTICS;  COMPRE- 
HENDING  THE  NATURAL  HISTORY,  PREPARATION,  PROPERTIES, 
COMPOSITION,  EFFECTS,  AND  USES  OF  MEDICINES,  BY  JONATHAN 
PEREIRA,  M.D.,  F.R.S.,  Assi.-tant  Phy.-ician  to  the  London  Hospital,  &c. 

Pan  I,  contain."  tlie  General  Action  and  Classilicatiim  of  Medicine,",  and  the  Mineral  Materia  Medica. 
Tart  II,  the  Ve^'euiljle  and  Animal  Kiii;;doins,  and  iueludins  iliairrams  iwplanatory  of  the  Processes  of 
th"  l'liarniaco|xi'ias,  a  Tahular  view  of  the  History  of  the  Alateria  Medira,  from  the  earliest  times  to  the 
presiMit  d;iv,  .aud  a  very  cnpious  index.  From  the  Sicmid  London  Edition,  which  has  been  thonuighly 
revisi'd,  with  the  Introduction  of  the  Processes  of  the  New  Rdinburj;li  Pharmacopcnia,  .Tiid  containing 
adililioiial  articles  on  Mcuilal  Remedies.  I.ijilit.  Ileal,  Cidd,  Klcrtricity,  .Ma^'uelism,  Flxercise,  Dietetics, 
and  t'limale,  and  many  additional  Wool  Cuts,  illushative  of  Pharinaceutical  Opcralions,  Crystallogra- 
phy, Shape  and  (Organization  of  the  Feiulas  of  Ciunmerce,  and  the  Natiir;il  History  of  the  Materia  Mi'dica. 

'I'iie  object  of  the  author  has  been  to  sup|i!y  the  Meilical  Slndent  with  a  Class  liook  on  Materia  Medica. 
conlainiu!.'  a  fiithtul  outline  of  this  Departmeiil  of  .Medicine,  which  shoulil  cinhrace  a  concise  account 
of  the  most  imporlant  modern  discoveries  in  .Catural  History,  Chemistry,  I'hysiology,  and  Therapeutic.'' 
in  so  far  as  tliey  pertain  to  Pharmacology,  and  treat  the  subjects  in  the  order  of  tlieir  natural  historical 
relation?.  ( 

This  great  Library  or  Cyclopedia  of  Miieria  Mrdica  hna  been  fully  revised,  the  errors  corrected,  anil 
numerous  additions   made,  by  DR.  JOSEPH  C.VRSUN,  Professor  of  Materia  Medica  and  Pharmacy  in  | 
the"C(dlege   of  Pharmacy,"  and  forms  Two  Vidumes,  octavo,  of  near  lliOO  lar^e  and  closely-printed' 
pages;  and  it  in,iy  be  fully  relied  upon  as  a  permancat  and  standard  work  for  the  country,— embodying, 
as^it  does,  full  references  to  Ihc  U.  S.  Pharinacopea  and  au  account  of  the  Medicinal  Plania  indif^e- 
nous  to  the  United  Stales. 

PRINCirLES  AND  PRACTICE  OF  SURGERY,  WITH  CUTS. 

THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY,  BY  RO- 
BERT DRUITT.  From  the  Second  London  Edition,  illustrated  with  fifty  wood  en- 
piavings,  with  notes  and  comments  by  Joshua  B.  Flint,  M.D.,  in  one  volume  8vo.,  at 
a  low  price. 

EXTRACT   FROM    THE    ALTItOR's    PRKFACE. 

'•  The  arrangement  of  a  work  of  Ibis  kind  ought  not,  as  I  conceive,  to  lie  regarded  as  a  matter  ofmere 
iiwiitfi  reec.-,  or  at  most  of  convenience,  but  it  onjjhl  lo  embody  in  it  something  of  a  principle;  ami  I 
I.,  lieve  that  the  arrangement  of  this  work  may  be  us.ful  to  the  student,  by  sho\Mng  hini  Ml  what  order 
he  mav  best  prosecute  bis  researches  into  Hie  principles  of  his  profession.  .      ., 

"  Of  the  live  tarts  into  v.  bich  it  is  divided,  the  first  two  are  more  especially  ilevoted  to  the  principle!", 
and  the  three  <dli.  rs  to  the  practice  of  snrgerv.  The  tirst  part  treats  of  the  disturbances  of  the  constilu- 
lion  at  lap'p  that  maybe  produced  by  injiirv  or  di.sease  of  a  part;  beginning  with  the  simple  famlness 
or  ((dlaixe'll'iat  follows  a  blew,  and  preceediiiL'  to  coi.sider  the  varieties  of  f.  ver  and  tetanus. 

'•TI.e  second  part  df  scribes  what  m«v  bi}  called  the  ebininis  of  local  di.sease;  that  is  lo  say,  those 
morbid  changes  of  structure  or  function",  v  bich  are  pr<dnce,|  either  iinmedialely  by  e.vternal  causes,  or 
secomlarilv,  tliroiith  .s<uiip  deviation  fnun  lieallh.  kc.  .,,.,.  u      •      i  •    • 

"  The  tbiril  r.art  treats  of  the  various  kinds  of  injuries,  tieginning  with  the  simplest  mechanical  inju- 
ries ;  then   proceeding  lo  the  elfects  of  chemical  agents,  and  Lastly,  considering  the  ctfecls  of  annual 

'  "'The  fourth  i>art  considers  the  various  tissues,  organs,  and  regions  of  Hie  body  in  order,  and  describes 
the  various  acciileuils  they  are  liable  lo,  kr.  ...,.,,  .      . 

"  The  fifth  part  ile«cribe«  such  of  the  operations  as  were  not  included  in  the  former  parts.  &c. 

••  To  the  whole  is  appended  a  collection  of  formula-,  the  niimb.r  of  which  is  very  much  increased  in 
thi.s  edition." ^ 


LEA    &    BLANCHARD'S    PUBLICATIONS. 

FEVERS  OF  THE  UNITED  STATES. 

THE  HISTORY,  DIAGNOSIS    AND  TREATMENT  OF   TYPHOID  AND 

TYPHUS  FEVER,  WITH  AN  ESSAY  ON  THE  DIAGNOSIS  OF  BILIOUS 

REMITTENT  AND  OF  YELLOW  FEVER,  BY  ELISHA  BARTLETT,  M.D., 

Professor  of  tlie  Theory  and  Practice  of  Medicine  in  the  Transylvania  University, 

In  one  volume  8vo;  a  new  work. 

Notice  lias  alreaiiy  been  given  of  the  appearance  of  this  work  :  we  have  become  satisfied  of  its  sterling 
value,  and,  lliiTefore,  without  hesitalioii,  foel  justified  in  again  recommending  it  to  the  immediate  no- 
lice  of  practitioners. — Boston  Medical  and  Surgical  Jourval. 


MULLER'S   PHYSIOLOGY. 

ELEMENTS  OF  PHYSIOLOGY ;  BY  J.  MULLER,  M.D.,  Professor  of  Ana- 
tomy and  Physiology  in  the  University  of  Berlin,  &.c.  Translated  from  the  German 
by  William  Baly,  M.D.,  Graduate  in  Medicine  of  the  University  of  Berlin.  Ar- 
ranged from  the  Second  London  Edition  by  .John  Bell,  M.D.,  Lecturer  on  Materia 
Medica  and  Therapeutics,  &c.,  &c.     In  One  Volume,  8vo. — Jusl  ready. 

In  arranginc  the  Vfdunie  now  offered  to  American  readers,  from  the  materials  furnished  in  Mullf.r's 
Elements  of  Physioi.og?,  the  E<litor  has  endeavoured  to  procure  reduction  in  size,  of  this  latter,  with- 
out any  abstraction  of  its  vitality  and  inind.  With  this  view  he  has  omitted,  for  the  most  part,  mere 
disquisitions,  many  details  of  experiments,  matters  of  physics  and  natural  philosophy,  including  mechan- 
ics under  the  liead  of  locomotion,  acoustics  and  (he  theories  of  music  utuler  voice  and  hearing,  and  of 
optics  under  vision, — much  of  the  minutii  of  comparative  physiology,  and  metaphysics  or  mntaphysico- 
physiology.  But,  while  excluding  details  on  collateral  topics,  the  Echtor  has  been  particularly  careful  to 
preserve  Physiology  Proper,  which,  resting  on  the  basis  of  llistogeiiy  and  General  Anatomy,  derives 
important  aid  from  Organic  Chemistry  anil  Microscopical  Observations,  and  in  its  turn  servos  to  illus- 
trate Hygiene,  Pathology  and  Therapeutics.  Thus  aided  and  thus  applied,  in  the  manner  exhibited  by 
Miiller  iiiuiself,  Physiology  will  invite  the  attention  of  the  Student  in  these  pages. 

It  will  soon  be  discovered  that,  althougli  this  volume  is  an  abridgement  of  the  large  work  of  Miiller,  it 
may  rightfully  claim  to  be  cousidered  a  complete  system  of  Physiology,  exceeding  in  copiousness  and 
comprehensive  details,  any  other  work  on  the  same  subject  which  has  yet  emanated  from  the  London 
press. 

ELEMENTS  OF  PHYSICS -WITH  WOOD-CUTS. 

ELEMENTS  OF  PHYSICS,  OR  NATURAL  PHILOSOPHY,  GENERAL 
AND  MEDICAL.  A  Nev/  Edition,  complete  in  One  Volume,  written  for  universal 
use,  in  plain  and  non-teciinical  language,  and  containing  New  Disquisitions  and  Prac- 
tical Suggestions;  comprisfd  in  Five  Parts:  1.  Somatology,  Statics  and  Dynamics. 
2.  Mechanics.  3.  Pneumatics,  Hydraulics  and  Acoustics.  4.  Heat  and  Light. 
5.  Animal  and  Medical  Physics.  By  NEIL  ARNOTT,  M.D.,  of  the  Royal  College 
of  Physicians.  A  New  Edition,  revised  and  corrected  from  the  last  English  Edition  ; 
willi  additions  by  Isaac  Hays,  M.D.,  and  numerous  Wood-cuts. 


PRACTICAL  MINERALOGY  AND  GEOLOGY— WITH  CUTS. 

A  TEXT-BOOK  OF  GEOLOGY  AND  MINERALOGY,  WITH  INSTRUC- 
TIONS FOR  THE  QUALITATIVE  ANALYSIS  OF  MINERALS.  BY 
JOSHUA  TRIMMER,  F.G.S.,  witli  Two  Hundred  and  Twelve  Wood-cuts.  A 
handsome  Octavo  Volume,  bound  in  embossed  cloth. 

This  is  a  Systematic  Introduction  to  Mineralogy  and  Geology,  admirably  calculated  to  instruct  the 
Student  in  those  sciences.  The  Organic  Remains  of  the  various  Formations  are  well  illustrated  by 
numerous  Figures,  which  are  drawn  with  great  accuracy. 

ELLIS'S  MEDICAL  FORMULARY  IMPROVED. 

THE  MEDICAL  FORMULARY  OF  DR.  ELLIS;  being  a  COLLECTION 
OF  PRESCRIPTIONS,  derived  from  the  Writings  and  Practice  of  many  of  the  most 
eminent  Physicians  in  America  and  Europe.  To  which  is  added  an  Appendix,  con- 
taining the  usual  Dietetic  Preparations  and  Antidotes  for  Poisons;  the  whole  accom- 
panied with  a  few  brief  Pharmaceutic  and  Medical  Observations.  By  BENJAMIN 
ELLIS,  M.D.  The  Seventh  Edition,  completely  revised,  with  many  Additions  and 
Modifications,  and  brought  up  to  the  present  improved  state  of  the  Science;  by  Samuel 
Gkorge  Morton,  M.D.,  Professor  in  the  Pennsylvania  College  of  Medicine,  &c.,  &c. 
In  One  Octavo  Volume. 


LEA    fc    BLANCH  A  RD'S    PUBLICATIONS. 

PRINCITLES   OF   MEDICINE. 

THE  FIRST  PRINCIPLES  OF  MEDICINE,  BY  ARCHIBALD  BILLING, 
M.I).,  A.M.,  Member  of  the  Senate  of  the  University  of  London,  Fellow  of  the  Royal 
College  of  Physicians,  &,c.,  «S:.c.  In  One  Volume,  8vo.  First  American  from  the 
Fourth  London  Edition. 

"  Wi'  kiKuv  (if  mi  liodk  whirl)  rniitains  w  illiiii  llie  panic  space  so  imirli  vnliinliU?  iiifur?iiatinn,  llji'  i-psiilt 
IKU  i>r  raiiciCiil  tlioory,  imr  ol'iiili;  liypnUifsis,  Imt  dl'  c'lii.>(',  pirscvoriiif;  Clinical  (Jlisii  vatioii,  aiT<MipaiiiL'cl 
Willi  iiiiich  soumliicss  ofjiHigiiiuiit,  ami  eMruoniiuary  clinical  lai.l."—jMcilirvC/iiruri;ical  liericw. 

A  DISSERTATION  ON  THE  DISEASES  OF  THE  MAXILLARY  SINUS. 
By  Chapin  A.  Harris,  M.D.,  D.D.S.     In  one  volume,  8vo. 

COATES'S  POPULAR  MEDICINE,  OR  FAMILY  ADVISER,  consisting  of 
Outlines  of  Anatomy,  Physiology,  and  Hygiene,  with  such  Hints  on  the  Practice  of 
Physic,  Surgery,  and  the  Diseases  of  Women  and  Cliildron,  as  may  prove  useful  in 
families  when  regular  Physicians  cannot  be  procured  :  being  a  Companion  and  Guide 
for  intelligent  Principals  of  Manufactories,  Plantations,  and  Boarding  Schools;  Heads 
of  Families,  Masters  of  Vessels,  Missionaries,  or  Travellers;  and  a  useful  Sketch  for 
Young  men  about  commencing  the  Study  of  Medicine.     By  Reynell  Coates,  M.D. 

This  work  is  designed  to  supply  the  place  of  Ewella'  Medical  Companion,  which  is 
now  entirely  out  of  print. 

OUTLINES  OF  A  COURSE  OF  LECTURES  ON  MEDICAL  .JURISPRU- 
DENCE.   By  Thomas  Stewart  Traill,  M.D.,  with  notes  and  additions.  A  small  volume. 

A  PRACTICAL  TREATISE  ON  MEDICAL  JURISPRUDENCE,  with  so 
much  of  Anatoin)',  Physiology,  Pathology,  and  the  Practice  of  Medicine  and  Surgery, 
as  are  Essential  to  be  known  by  Members  of  the  Bar  and  Private  Gentlemen;  and  all 
the  Laws  relating  to  Medical  Practitioners;  with  Explanatory  Plates.  By  J.  Chitty, 
Esq.,  second  American  edition,  with  notes  and  additions  adapted  to  American  Works 
and  Judicial  Decisions.     In  One  Volume  Octavo. 

ABERCROMBIE  ON  THE  BRAIN.  Pathological  and  practical  Researches  on 
Diseases  of  the  Brain  and  Spinal  Cord.     New  edition,  1  vol.  8vo. 

A  PRACTICAL  TREATISE  ON  THE  HUMAN  TEETH,  showing  the  causes 
of  their  destruction  and  the  means  of  their  preservation,  by  William  Robertson.  With 
plates.     Fir.st  American  from  the  second  London  Edition.     In  one  volume  octavo. 

ANATOMY,  PHYSIOLOGY,  AND  DISEASES  OF  THE  TEETH.  By 
Thomas  Bell,  F.R.S.,  F.L.S.,  &c.  Third  American  edition.  la  one  volume  octavo, 
with  numerous  plates. 

DISSERTATIONS  ON  NERVOUS  DISEASES.  By  Drs.  James  Hope,  J.  C. 
Prichard,  John  Hughes  Bennett,  Robert  H.  Taylor  and  Thcophilus  Thomson.  In  one 
volume  octavo. 

DISSERTATIONS  ON  DISEASES  OF  THE  ORGANS  OF  RESPIRATION. 
Bv  Drs.  Williams,  Theophilus  Thomson,  W.  B.  Carpenter,  and  W.  Bruce  Joy.  In 
one  volume  octavo. 

DISSERTATIONS  ON  FEVERS,  GENERAL  PATHOLOGY,  INFLAMMA- 
TION, AND  DISEASES  OF  THE  SKIN.  By  Drs.  Symonds,  Allison,  Christison, 
&c.  &c.     In  one  volume  octavo. 

DISSERTATIONS  ON  DISEASES  OF  THE  DIGKSTIYE,  URINARY  AND 
UTERINE  ORGANS.  By  Drs.  Joy,  Symonds,  Thomson,  Ferguson,  &.c.  &c.  In 
one  volume  octavo. 

DISSERTATIONS  ON  H/RMORRHAGES,  DROPSY,  RHEUMATISM, 
GOUT,  SCROFULA,  &c.  &c.  By  Drs.  Burrows,  "Watson,  Shapter,  Joy,  &.c.  &c. 
In  one  volume  octavo. 

The  above  five  volumes  are  from  the  Library  of  Practical  Medicine,  edited  by  Dr. 
Twecdie,  with  notes  by  Dr.  Gerhard.  Each  volume  is  complete  within  itself,  and  is 
for  sale  separately. 

A  TREATISE  ON  PROTRACTED  INDIGESTION  AND  ITS  COxNSE- 
QUENCES.  B'jing  the  application  to  the  practical  de|)artment  of  Medicine  o!  the 
Results  of  an  Iiui'iiry  into  the  Laws  of  the  Vit,il  Functions.  By  A.  P.  \\  .  Philip,  M.D., 
F.R.S.,  &c.  &c.  From  the  Eightii  London  Edition.    Inlvol.8vo. 


WORKS   ON 

MEDICINE,    SURGERY, 

ANATOMY,  MIDWIPEKY, 

AND  THE  COLLATERAL  SCIENCES, 

PUBLISHED    BY 

LEA   &   BLANCHARD, 
PHILADELPHIA, 

AND  FOR  SALE  BY  ALL  BOOKSELLERS. 

MIDWIFERY  ILLUSTRATED. 

THE  PRL\CIPLES  AND  PRACTICE  OF  OBSTETRIC  MEDICINE  AND 
SURGERY,  IN  REFERENCE  TO  THE  PROCESS  OF  PARTURITION; 
ILLUSTRATED  BY  ONE  HUNDRED  AND  FORTY-TWO  FIGURES.  BY 
FRANCIS  H.  RAMSBOTHAM,  M.D.,  Physician  to  the  Royal  Maternity  Charity, 
and  Lecturer  on  Midwifery  at  the  London  Hospital,  &c.  Second  American  edition, 
revised,  in  one  larofe  octavo  volume. 

"  Anions  llie  many  literary  iindorlnkings  w  itii  which  the  Me(lii;!il  press  at  present  teeins,  there  are  few 
that  deserve  a  warmer  recoinnieinlation  at  our  hajult^  than  Ihe  work— we  nii;:lit  ahiinst  .=ay  the  obstetrical 
lilirarij.  cninpriseil  in  a  single  volume— wliirh  is  now'  bcfurc  us.  Few  workssnrpass  Dr.  Rnnii-hdtliam's  in 
tiraiity  and  elegance  of  L'eltinf;  up,  and  in  tlie  abundant  and  e.xcellent  En{;ravini;s  with  wliich  it  is  ilhus- 
trated.  IVe  he:irlily  wjsli  tile  Volnine  tlie  sncccss  which  it  merits,  and  we  have  no  ihiiilit  tliat  before 
loni;  it  will  ocrnpy  a  piare  in  every  Medical  Library  in  the  kiiii'doin.  The  Flhistrations  are  admirabli' ; 
Ihey  are  the  joint  production  of  Baj;^  and  Ailiard  ;  and  comprise,  «'ithin  the  series,  the  iiest  t)I)Stitrical 
Plates  of  our  bi'st  ub^tptril■al  authors,  ancient  and  modern.  Many  of  the  Kngravings  are  calculated  to 
fix  the  eye  as  MUicli  by  ilieir  exc(dlence  of  ejeciiliori  and  their  beauty  as  works  of  art,  as  by  their  fidelity 
to  naturi.'  ami  a:iat"mical  accuracy. "— 7V/f  I.nncet. 

"It  is  a  s.o"'''  and  Ihorou^'lily  Practical  Treatise;  the  diderent  subjects  are  laid  down  in  a  clear  and 
perspicuous  form,  and  whatever  is  of  iniporlaiice  is  illustrated  by  first-rate  Enj,'ravinj;s.  As  a  work 
conveying  (jood,  sound,  prnclical  precepts,  nod  clearly  deinonstratini!  Ihe  (hictrines  of  Obstetrical  Science, 
we  can  confidently  recotiimcnd  it  either  to  the  Student  or  Practitioner.  —  Edinbtirgh  Journal  of  Medical 
Science. 

DUNGLISON'S  PRACTICE  OF  MEDICINE. 

THE  PRACTICE  OF  MEDICINE;  OR  A  TREATISE  OX  SPECIAL 
PATHOLOGY  AND  THERAPEUTICS;  BY  ROHLEY  DUNGLISON,  M.D., 
ProfoFsor  of  the  Institutes  of  Medicine,  &c.,  in  the  Jefl'er.son  Medical  Colleofe,  Phila- 
delplti^i;  Lecturer  on  Clinical  Mediciuc,  and  attendiii<r  Physician  at  the  Philadelphia 
Hospital,  (to. ;  coniaininjr,  the  Diseases  of  the  Alimctitiiry  Canal — the  Diseases  nf  the 
Circulatory  Apparatus — Diseases  of  the  Glandular  Oro-ans — Diseases  of  the  Organs 
of  the  Senses — Diseases  of  the  Respiratory  Orjrjins — Diseases  ot  the  Glatidifonu  Gan- 
glions— Diseases  of  the  Nervous  System — Diseases  of  the  Organs  of  Reproduction — 
Diseases  involvinsr  various  Organs,  &c.,  &c.     In  two  volumes,  octavo. 

The  oliif'ct  of  ihi^  work  is  to  place  before  the  Practitioner  and  Student  a  Treatise  on  the  various  Dis- 
eases lif  Ihe  Iluiii'in  ( Jr^anisin,  which  shall  comprise  the  Svinptoms,  Causes,  Pro;;nostics  and  'I'reatment, 
in  such  f.>-m  as  to  be  easy  of  ri^ference,  and  a  Irustv,  orUi)  t'uide  in  practice,  yi  contains  not  only  l.he 
Virus  of  the  Ai.lhor,  on  all  tlnse  poinis,  derived  from  extensive  opportunities  for  observation,  but  those 
of  Ihe  r!istin'.';iishiil  obser\ers  of  the  <!ay  in  every  part  of  the  world  ;  and  treats  of  a  greater  number  of 
Diseases  than  perhaps  any  other  "  Practice  of  Medicine." 

BERZELIUS  ON  THE  KIDNEYS,  ETC. 

THE  KIDNEYS  AND  URINE,  BY  J.  J.  BERZELIUS.     Translated  from 
the  German  hy  M.  H.  Boye,  and  F.  Leaming,  M.  D.     In  one  Volume,  8vo. 


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